Transient and Isolated Neurogenic Blepharoptosis After Medial Orbital Wall Reconstruction

Abstract

Neurogenic blepharoptosis related to orbital surgery is very rare and only 1 report was published in the literature. This report presents 1 case of transient and isolated neurogenic blepharoptosis after medial orbital wall reconstruction. A 12-year-old male patient who suffered from periorbital trauma visited our hospital with right periorbital pain. During the physical examination, mild ecchymosis and eyelid edema were reported; however, there were no signs of either limitation of ocular motion or anisocoria. On the orbital CT images, a 17 mm × 20 mm-sized medial orbital bony defect was observed and the medial rectus muscle and orbital fat were herniated. The operation was performed 12 days after injury and the transcaruncular approach was used to reach the medial orbital wall. After the operation, he had right side blepharoptosis with mild eyelid edema and ecchymosis. However, ocular movement was normal and there were no signs of anisocoria. He did not receive any additional medication for blepharoptosis and was discharged 3 days postoperation. By the ninth day of postoperative recovery, the patient still suffered from right blepharoptosis with no levator palpebrae superioris muscle function. We prescribed a low dose of oral corticosteroid and the patient was monitored on a weekly basis. Finally, he recovered completely with normal symmetric eyelid position and levator function.

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

“…Although there is no official definition of TTINP, according to the literature, TTINP has at least two identical characteristics: a) TTINP occurs secondary to direct or indirect injury of the upper eyelid and its innervation; b) self-limited with recovery after a certain period of time with conservative treatments or just observation [ 2 , 5 , 6 ]. There are also several reports of isolated ptosis after medial wall reconstruction of the orbit [ 5 , 6 ]. However, nearly all the reported cases are either secondary to direct periorbital trauma or surgery [ 2 , 3 , 5 , 6 ].…”

“…There are also several reports of isolated ptosis after medial wall reconstruction of the orbit [ 5 , 6 ]. However, nearly all the reported cases are either secondary to direct periorbital trauma or surgery [ 2 , 3 , 5 , 6 ]. To the best our knowledge, this is the first report of TTINP with no direct trauma of the periorbital region.…”

“…The management of TTINP differs in different reports, ranging from simple treatments of the primary diseases to corticosteroid administrations [ 2 , 3 , 5 ]. However, there is no difference in the duration of recovery process, which ranges from two weeks to six months regardless of chosen treatment options in reported literature cases [ 2 , 3 , 5 , 6 ].…”

“…The management of TTINP differs in different reports, ranging from simple treatments of the primary diseases to corticosteroid administrations [ 2 , 3 , 5 ]. However, there is no difference in the duration of recovery process, which ranges from two weeks to six months regardless of chosen treatment options in reported literature cases [ 2 , 3 , 5 , 6 ]. Although previous reports have shown that some patients with complete oculomotor nerve palsy benefit from some invasive managements, TTINP might manifest as a unique entity with a relatively mild, reversible, and non-devastating injury to the terminal branch of nerve and for which perhaps no special treatment is needed [ 7 ].…”

Spontaneous resolution of isolated neurogenic blepharoptosis after blunt trauma

“…The mechanism for the neurogenic injury could be by stretching occurring in direct or indirect trauma [ 7 , 11 ] or ischemic injury during orbital wall reconstruction. [ 8 , 9 ] The reason for the recovery in our case could be that the neural damage was not caused by axonal degeneration but by neurapraxia, which is a temporary interruption in the conduction of nerve impulses. Traumatic blepharoptosis can also be caused by direct injury to the aponeurosis or the LPS, or by aponeurotic disinsertion or dehiscence.…”