Mechanical Blepharoptosis and Eyelid Swelling Caused by Silicone Oil

Abstract

The purpose of this article is to report a case of upper eyelid mechanical ptosis caused by silicone oil migration in a Jordanian patient after pars plana vitrectomy and intraocular silicone oil injection. A 20-year-old male patient was referred to the oculoplastic clinic for the management of a left upper eyelid swelling and complete ptosis that developed 12 years after pars plana vitrectomy and silicone oil placement for retinal detachment secondary to perforating eye injury. Eye examination showed upper eyelid swelling and a complete ptosis induced by the weight of inflammatory tissue and silicone oil, as proved by histopathologic examination. We presumed that silicone oil had leaked through the pars plana vitrectomy ports or through a subtle traumatic perforation of the posterior segment, which might have been aggravated by increased intra-ocular pressure postoperatively. In conclusion, mechanical ptosis caused by silicone oil migration after retinal detachment surgery is rare and this is one of the few reports in the literature. RESUMENEl objetivo de este artículo es describir un caso de ptosis mecánica del párpado superior causada por el desplazamiento del aceite de silicona. Este caso se observó en un paciente jordano tras someterse a vitrectomía pars plana y a una inyección intraocular de aceite de silicona. Un paciente varón de 20 años de edad fue derivado a la unidad de oculoplastia para el tratamiento de la inflamación del párpado superior izquierdo y de una ptosis completa, aparecidas 12 años después de someterse el paciente a una vitrectomía pars plana y a la colocación de aceite de silicona para el desprendimiento de retina que se produjo a consecuencia de un traumatismo ocular perforante. En la exploración ocular se apreció una inflamación en el párpado superior, así como ptosis completa provocada por el peso del tejido inflamado y por el aceite de silicona, tal y como demuestra el examen histopatológico. Supusimos que el aceite de silicona se había filtrado a través de los puertos de la vitrectomía pars plana o a través de una leve perforación traumática del segmento posterior, hecho que podría haberse visto agravado por un aumento de la presión intraocular ocurrido tras la operación. Como conclusión: la ptosis mecánica causada por el desplazamiento del aceite de silicona inyectado para tratar un desprendimiento de retina es poco frecuente; de hecho, éste es uno de los pocos casos que se encuentran en la literatura.

Migration of Silicone Oil into the Orbit and Eyelid as a Cyst

“…Dehiscence of the levator aponeurosis was not observed in the current case, but it was reported in previous case reports [ 14 ].…”

“…Intraocular silicone oil is associated with a number of complications such as glaucoma, cataract, subretinal migration of silicone oil, and proliferation of epiretinal and subretinal fibrosis, keratopathy, and in rare situations the migration of silicone oil into the orbit. Migration of silicone oil into the orbit and upper eyelid was also reported after retina surgery following pars plana vitrectomy due to proliferative diabetic retinopathy [ 6 ], endogenous endophthalmitis [ 13 ] and penetrating eye trauma [ 14 ].…”

Postoperative Blepharoptosis After Pars Plana Vitrectomy Procedure

“…However, there are a few case reports of postoperative ptosis due to migration of silicone oil into the upper eyelid. [17][18][19][20][21][22][23] It usually occurs between 3 and 19 years after the procedure and is associated with eyelid inflammatory signs such as erythema and swelling which is not consistent with the series. [17][18][19][20][21][22][23] One of the reasons for postoperative ptosis after intraocular procedures has been myotoxic and neurotoxic effects of the local anesthesia.…”

Dellen formation as a complication of subconjunctival silicone oil following microincision vitrectomy

“… 17 One of the complications of intraocular SO tamponade is its extraocular seepage. Studies have reported escape of SO and its migration into the eyelid with mechanical blepharoptosis, 18 cerebral migration, 19 migration in the SC space (through Molteno implant 5 or Ahmed glaucoma valve 20 ), and formation of SC cysts. 21 Hyung and Min reported dellen disappearance after removal of SCSO.…”