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Endocrine Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Lid lag is present in any form of hyperthyroidism. The levator palpebrae superioris (LPS), partly sympathetically innervated, is affected by increased catecholamine sensitivity. Spasm of the LPS causes upper eyelid retraction and a typical ‘stare’. Blinking is frequent with eye grittiness. The sclera is visible above the cornea. Less severe lid retraction is elicited by demonstrating lid lag.
Clinical Neuroanatomy
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The eye is often injected with chemosis. Lid lag is especially noticeable on downward gaze. There may be diplopia simply due to globe displacement, but actual paralysis of the superior and lateral rectus muscles is a specific feature. In spite of its metabolic basis, the condition is usually unilateral. Vision may be threatened and acute high-dose steroids may be of value in treatment. A CT or MRI scan will usually show marked swelling of the extraocular muscles.
Answers
Published in John D Firth, Professor Ian Gilmore, MRCP Part 2 Self-Assessment, 2018
John D Firth, Professor Ian Gilmore
The left eye has failed to abduct due to a left sixth nerve palsy. The sclerae can be seen above the iris of both eyes indicating the presence of lid retraction. Lid lag is demonstrated by asking the patient to look at an object moved from superior to inferior in the visual field and cannot be determined from a still photograph of a patient attempting to look to the left.
Conjoint fascial sheath suspension with levator muscle advancement for severe blepharoptosis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Yucheng Qiu, Rui Jin, Xue Dong, Yirui Shen, Feixue Ding, Zhizhong Deng, Xianyu Zhou, Youcong Ning, Jun Yang, Fei Liu
Frontalis suspension is the most common treatment for severe blepharoptosis. Nevertheless, because of the external orbital lifting force of the frontalis, it often changes the elevating direction of the upper eyelids and results in complications, such as lagophthalmos, aggravating forehead furrows and exposure keratitis. Postoperatively, a high recurrence rate and low satisfaction rate are common [23,24]. The novel technique described in this study utilises the levator muscle and CFS as suspension forces. Compared with the frontalis, the levator provides an internal orbital lifting force and lifts the upper eyelid in a physiological manner. The driving force of the CFS relies on the superior rectus, which moves parallel to the levator muscle. Therefore, our technique creates a more dynamic eyelid and eyeball coordination movement, and the occurrence rate of severe complications, such as exposure keratitis and lid lag, is low, as recorded in this study. Compared to the 6.7% recurrence rate of the described technique, the recurrence rates in reports of frontalis suspension by Lee et al. [25] and Bouazza et al. [26] were 12.5% and 14.3%, respectively, indicating that levator muscle suspension combining CFS suspension provides a lower relapse rate. Moreover, with a 93.3% adequate or normal correction rate, the modified technique provided a better efficacy than simple CFS suspension, compared to the 75% correcting rate of severe ptosis group in Santanelli et al.’s report [17].
An atypical case of unilateral vision loss in thyroid eye disease
Published in Clinical and Experimental Optometry, 2020
Teena M Mendonca, Shobha G Pai, Shrinath P Shetty, Ria Mukherjee, Tishya Vepakommma
Anterior segment examination showed mild conjunctival hyperaemia in both eyes (Figure 1A). Pupillary reaction in the right eye was normal. In the left eye pupillary reactions were sluggish with a relative afferent pupillary defect (RAPD) (Grade 2).1993 Extraocular motility examination (ductions and versions) revealed mild limitation of adduction in the right eye and significant limitation of depression and adduction in the left eye (Figure 1B). The fundus examination was normal in the right eye (Figure 2A). The fundus examination of the left eye showed optic disc oedema and dilated, tortuous retinal vessels (Figure 2B). Intraocular pressure was 15-mm Hg in both eyes. The patient did not have lid retraction. On careful evaluation, lid lag in downgaze was present in both eyes. Visual field evaluation (Humphrey visual field analysis 30‐2) was normal in the right eye, while a generalised depression of sensitivity was noted in the left eye.
Salzmann’s nodular degeneration of cornea associated with thyroid eye disease
Published in Orbit, 2019
Michael C. Yang, Saba Al-Hashimi, Daniel B. Rootman
Subjectively, she complained of tearing, itching, ocular surface sensitivity and dry eyes. Corneal examination revealed bilateral elevated lesions superomedially in a symmetric pattern. Vision was reduced on the left to 20/40 without correction, but pinhole improved vision to 20/20. Bilaterally, MRD1 and MRD2 were 5.5 mm and 4 mm, respectively, Hertels exophthalmometry measured 17 mm OU (base 110 mm), and bilateral upper eyelid retraction was noted. Lagophthalmos and lid lag were not evident and normal blink cycle was demonstrated. The patient was diagnosed with TED, active stage, mild grade and referred for corneal evaluation for bilateral lesions.