The Long and Winding Road: Contact Lens-induced Ptosis

Abstract

Intrapalpebral migration is a rare complication of hard contact lens use. We report a case of a 52-year-old man who presented with right upper eyelid ptosis and requested cosmetic correction. He had no ocular history apart from myopia, which was corrected with the use of hard contact lenses. Prior to the ptosis he recalled losing his right contact lens during a bout of sneezing. He replaced the missing lens and continued to wear contact lenses as usual. After careful clinical examination, an ipsilateral small, mobile eyelid mass was detected, and orbital MRI verified the suspected presence of a hard contact lens. Following surgical removal and ptosis correction, the patient made a full recovery. The phenomenon of hard contact lens migration in the periocular tissues has been reported in the literature before, but most patients experienced symptoms of variable severity. In this patient, however, there were no symptoms to indicate the presence of a contact lens. This case highlights the importance of including intrapalpebral contact lens migration in the differential diagnosis of an eyelid mass or ptosis in patients.

Two Presentations of Upper Lid Migration of Rigid Gas-permeable Contact Lenses

“…[8][9][10][11] We present an additional two cases of gas-permeable lens migration with differing presentations and provide a review of the literature. Although this phenomenon has since been described in NTM, nontender mass; MPD, mucopurulent discharge; NT, nontender; MD, mucoid discharge; FBS, foreign body sensation; Y VA, decreasing visual acuity; LPS, levator palpebrae superioris; NA, not applicable; NS, not supplied.…”

“…10,11 Hard contact lenses are commonly missed by CT scans, 6,8,27 with only one case in the literature reporting detection of a foreign body in keeping with the lost lens. Although plain radiographs are inadequate at detecting contact lenses regardless of their type, 1,7,12,21 magnetic resonance imaging (MRI) and computed tomography (CT) scan have been able to demonstrate curvilinear densities in keeping with the lost lens when it is gas-permeable.…”

Eyelid ptosis

“…21,22 Since then, numerous accounts of similar occurrences have been published. [23][24][25][26][27][28][29][30][31][32][33] In the case of Tossounis et al, 32 a 52-year-old man presented with right upper eyelid ptosis and requested cosmetic correction. However, in the majority of these cases, patients presented complaining of an otherwise 'quiet' lump in the upper lid, which can be misdiagnosed as a chalazion.…”