Complete post‐traumatic ptosis: A mechanism for recovery?

Arden, Richard L.; Moore, Grant K.

doi:10.1288/00005537-198911000-00014

Cited by 10 publications

(6 citation statements)

References 19 publications

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“…However, transient traumatic isolated neurogenic ptosis (TTINP) is rather rarely reported in the literature [ 2 , 3 ]. To the best of our knowledge, nearly all the patients reported with TTINP have histories of direct injury to the periorbital region [ 2 – 4 ]. In this report, a case of TTINP secondary to countre-coup injury to the periorbital region was discussed.…”

Section: Introductionmentioning

confidence: 99%

Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report

Zhang

Zhu

et al. 2015

BMC Ophthalmol

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BackgroundTransient traumatic isolated neurogenic ptosis (TTINP) is a sporadically reported rare entity. However, to the best of our knowledge, nearly all the reported cases are either secondary to direct periorbital trauma or surgery. We would like to report on a case of TTINP with countre-coup injury of the periorbital region.Case presentationA 49-year-old female slipped and fell down while walking. She was hospitalized with a moderate headache and undisturbed mental state. The patient recalled that the force bearing point was her occipital region. Physical examination and computed tomography (CT) on admission showed right isolated ptosis and mild contusion and laceration in the bilateral frontal cortex. Further radiological investigation revealed nothing remarkable except for a fracture of the superior portion of the right medial orbital wall. She was managed conservatively and recovered completely in two months.ConclusionTTINP might manifest as a unique entity with a relatively mild, reversible, and non-devastating injury to the terminal branch of the oculomotor nerve and for which perhaps no special treatment is needed. The proposed mechanism is injury of the terminal branch of the superior division of the oculomotor nerve.

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Section: Introductionmentioning

confidence: 99%

Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report

Zhang

Zhu

et al. 2015

BMC Ophthalmol

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“…[ 8 9 21 ] Traumatic stretching or pulling of the lid is known to produce traumatic aponeurotic ptosis via disinsertion of the levator aponeurosis from the tarsal plate. [ 3 22 ] According to the mechanism and severity of injury, the degree of ptosis may range from mild to severe, and MRD1 deficits may be transient or permanent. [ 2 22 23 ] It is worth noting that ptosis cases presumed to be due to microtraumas such as contact lens usage or intraocular surgery were not included in this study.…”

Section: Discussionmentioning

confidence: 99%

“…[ 25 ] Mild T apo cases resolved well with non-operative management, perhaps due to the tissue tightening effects of fibroblast activity during the healing process after injury. [ 22 ] Complications including lagophthalmos and dry eye were the most common in the mechanical subgroup, which reflects the restricted lid excursion that often complicates cases involving cicatricial tethering.…”

Section: Discussionmentioning

confidence: 99%

Traumatic ptosis: Evaluation of etiology, management and prognosis

Jacobs¹,

Tyring²,

Amadi³

2018

J Ophthalmic Vis Res

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Introduction:To investigate whether a systematic approach to subgrouping traumatic ptosis according to etiology can allow for better tailoring of prognosis and treatment.Methods:Retrospective chart review of patients with trauma-related blepharoptosis managed by Oculoplastic surgery specialists at an academic medical center from January 1995 to November 2015. Injury mechanism, eyelid position and function, interventions, and outcomes were reviewed.Results:Of 648 patients treated for blepharoptosis, 55 (8.5%) were traumatic. Careful review revealed 4 subcategories of traumatic ptosis cases: aponeurotic (n = 16), myogenic (n = 18), neurogenic (n = 7), and mechanical (n = 14). Margin reflex distance (MRD1) at presentation was significantly worse for the myogenic subtype (-0.59 mm, SD ±2.09, P = 0.046). The aponeurotic subtype had the best average levator function at presentation (14.29 mm, SD ±2.05), while myogenic had the worst (8.41 mm, SD ±4.94) (P = 0.004). Thirty-five (63.6%) patients were managed surgically. Final MRD1 was significantly different for each subtype (P = 0.163), with aponeurotic 2.63 mm (SD ±1.01), myogenic 1.29 mm (SD ±2.24), neurogenic 1.79 mm (SD ±2.48), and mechanical 2.31 mm (SD ±1.18). There was a significant increase in MRD1 from presentation to final follow up across all groups (P < 0.05).Conclusion:Traumatic ptosis is heterogenous. Systematically evaluating traumatic ptosis cases by trauma mechanism can guide decisions about prognosis and management. Two-thirds of cases were treated surgically, with most patients responding well to conjunctiva-Müller resection or external levator advancement. While all subgroups demonstrated improvement in MRD1 at final follow up, aponeurotic cases had the best prognosis, while myogenic fared the worst and required the longest for maximal recovery.

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“…The outcomes of traumatic ptosis often range from injury to levator dysfunction due to palpebral laceration or orbital fracture caused by traffic accident, falling, and so on. [ 1 2 ] Blunt injuries are most common, whereas sharp injuries are rare. [ 1 2 3 4 ] In cases where >3 weeks have passed since the onset of the sharp injury of the skin or subcutaneous tissue, in terms of wound healing, the timing of the operation is usually secondary and performed after around 6 months.…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 2 ] Blunt injuries are most common, whereas sharp injuries are rare. [ 1 2 3 4 ] In cases where >3 weeks have passed since the onset of the sharp injury of the skin or subcutaneous tissue, in terms of wound healing, the timing of the operation is usually secondary and performed after around 6 months. [ 5 ] We report a rare case of levator aponeurotic defects resulting from a scratch caused by human hand that was treated with secondary surgery 2 months after the onset of injury, which is considered an inappropriate time.…”

Section: Introductionmentioning

confidence: 99%

A case of surgically treated traumatic ptosis caused by scratching by human hand

Nishioka

Shirakawa

Okada

et al. 2020

Taiwan J Ophthalmol

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The patient was a 49-year-old woman. She had worked at a child welfare facility where she sustained a wound to the left side of her upper eyelid after it was scratched by a child facility resident's finger. One month had passed since the injury when she visited our hospital. The initial treatment was not appropriate, and her left eyelid could not be lifted at all. A secondary surgery was performed 2 months after the injury when the scar contracture was most strong. Such corrective surgery for posttraumatic eyelid is typically scheduled after at least 6 months when the scar tissue softens from the viewpoint of wound healing. However, this case indicated the importance of determining the appropriate timing of surgery in consideration of the patient's background and the scientific basis. Reports of sharp traumatic ptosis are rare, and this is the first reported case of traumatic ptosis resulting from a scratch caused by human hand.

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Complete post‐traumatic ptosis: A mechanism for recovery?

Cited by 10 publications

References 19 publications

Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report

Transient traumatic isolated neurogenic ptosis after a mild head trauma: a case report

Traumatic ptosis: Evaluation of etiology, management and prognosis

A case of surgically treated traumatic ptosis caused by scratching by human hand

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