ABSTRACT
Background: Cerebral ptosis is understood as the bilateral paralysis of eyelid elevation linked to a stroke or hemorrhage of the middle cerebral artery (MCA). It is a transient condition, independent of the evolution of the lesion. Aim: To analyze six patients with the condition. Patients and Methods: Report of five women and one male aged 42 to 72 years. Results: All suffered an infarction or hemorrhage in the territory of the middle cerebral artery of the non-dominant hemisphere and developed a bilateral palpebral ptosis. The recovery started after the fourth day. At the tenth day, eye opening was effortless and did not require frontal help, despite the persistence of hemiplegia. Conclusions: Cerebral ptosis is a mimetic dysfunction of a specific non-injured area of the cerebral cortex, originated from a nearby parenchymal damage such as the middle cerebral artery of the same hemisphere. Cerebral ptosis expresses the inhibition of the voluntary eyelid elevation center, of prefrontal location in the non-dominant hemisphere.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Blepharoptosis/diagnostic imaging , Cerebral Infarction/diagnostic imaging , Middle Cerebral Artery/diagnostic imaging , Blepharoptosis/physiopathology , Blepharoptosis/therapy , Tomography, X-Ray Computed , Cerebral Infarction/physiopathology , Cerebral Infarction/therapy , Middle Cerebral Artery/physiopathologyABSTRACT
ABSTRACT The purpose of the study was to evaluate the frequency of ophthalmologic abnormalities in a cohort of myotonic dystrophy type 1 (DM1) patients and to correlate them with motor function. We reviewed the pathophysiology of cataract and low intraocular pressure (IOP). Method Patients were included after clinical and laboratory diagnosis and after signed informed consent. They were evaluated by Motor Function Measure scale, Portuguese version (MFM-P) and ophthalmic protocol. Results We evaluated 42 patients aged 17 to 64 years (mean 40.7 ± 12.5), 22 of which were men. IOP (n = 41) was reduced in all but one. We found cataract or positivity for surgery in 38 (90.48%) and ptosis in 23 (54.76%). These signs but not IOP were significantly correlated with severity of motor dysfunction. Abnormalities in ocular motility and stereopsis were observed. Conclusion Cataract and ptosis are frequent in DM1 and associated to motor dysfunction. Reduced IOP is also common, but appears not to be related with motor impairment.
RESUMO O objetivo do estudo foi avaliar a frequência das anormalidades oftalmológicas em uma coorte de pacientes com distrofia miotônica tipo 1 (DM1) correlacionando-as à função motora. Revisamos a fisiopatogenia da catarata e baixa pressão intraocular (PIO). Método Os pacientes foram incluídos após diagnóstico clínico-laboratorial de DM1. Aqueles que assinaram o termo de participação foram avaliados pela escala medida da função motora, versão em português (MFM-P) e protocolo oftalmológico. Resultados Avaliamos 42 pacientes de 17 a 64 anos (média 40,7 ± 12,5), 22 do sexo masculino. Encontramos catarata ou positividade de cirurgia em 38 (90,48%) e blefaroptose em 23 (54,76%) e esses sinais foram correlacionados significativamente à maior gravidade da disfunção motora. Baixa PIO também foi comum e não correlacionada à gravidade motora. Alterações da motilidade ocular e de estereopsia ocorreram. Conclusão Catarata e ptose palpebral são frequentes na DM1 e associadas à gravidade motora. Baixa PIO é comum e parece ser independente da evolução motora.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Blepharoptosis/etiology , Cataract/etiology , Intraocular Pressure/physiology , Myotonic Dystrophy/complications , Blepharoptosis/physiopathology , Cataract/physiopathology , Myotonic Dystrophy/physiopathologyABSTRACT
We report a case of surgical treatment for Hallermann-Streiff syndrome in a patient with ocular manifestations of esotropia, entropion, and blepharoptosis. A 54-year-old man visited Yeouido St. Mary's Hospital complaining of ocular discomfort due to cilia touching the corneas of both eyes for several years. He had a bird-like face, pinched nose, hypotrichosis of the scalp, mandibular hypoplasia with forward displacement of the temporomandibular joints, a small mouth, and proportional short stature. His ophthalmic features included sparse eyelashes and eyebrows, microphthalmia, nystagmus, lower lid entropion in the right eye, and upper lid entropion with blepharoptosis in both eyes. There was esodeviation of the eyeball of more than 100 prism diopters at near and distance, and there were limitations in ocular movement on lateral gaze. The capsulopalpebral fascia was repaired to treat the right lower lid entropion, but an additional Quickert suture was required to prevent recurrence. Blepharoplasty and levator palpebrae repair were performed for blepharoptosis and dermatochalasis. Three months after lid surgery, the right medial rectus muscle was recessed 7.5 mm, the left medial rectus was recessed 7.25 mm, and the left lateral rectus muscle was resected 8.0 mm.
Subject(s)
Humans , Male , Middle Aged , Blepharoptosis/physiopathology , Entropion/physiopathology , Esotropia/physiopathology , Eye Movements , Follow-Up Studies , Hallermann's Syndrome/surgery , Oculomotor Muscles/physiopathology , Ophthalmologic Surgical Procedures/methodsABSTRACT
OBJETIVO: Avaliar a diferença da função do músculo levantador da pálpebra superior (FMLPS), distância margem reflexo (DMR1) e altura do sulco palpebral (AS) antes e depois da cirurgia de blefaroplastia superior associada à correção de ptose palpebral. MÉTODOS: Quarenta e quatro pacientes com blefaroptose e dermatocálase foram incluídos. Intervenção: exploração do tendão do músculo levantador da pálpebra superior (MLPS) durante a blefaroplastia, em portadores de blefaroptose e dermatocálase. Nos casos de desinserção, o tendão foi refixado ao tarso. Desfechos analisados: foram analisados de forma bilateral a diferença entre FMLPS, DMR1 e AS antes e depois da intervenção. A dependência entre os olhos foi corrigida por meio de equações de estimativa generalizada. Foi utilizada a correlação de Pearson para quantificar a dependência entre os olhos para FMLPS, DMR1 e AS. RESULTADOS: Houve diferença significante entre as medidas de FMLPS antes e depois da cirurgia, havendo redução da excursão do MLPS após a cirurgia, diminuindo, em média, 1,1 mm (P<0,001). As medidas pré e pós-operatória de DMR1 e AS foram estatisticamente diferentes, sendo que a DMR1 aumentou, em média, 1,6 mm e a AS diminuiu, em média, 3,97 mm (P<0,001) após a cirurgia. Houve correlação significante entre os olhos para todas as variáveis propedêuticas antes e depois da cirurgia. As correlações pré-operatórias foram mais fortes no grupo sem cirurgia prévia. O mesmo foi encontrado para a correlação quanto ao grau de desinserção nos dois olhos (P>0,01). CONCLUSÃO: A função do músculo levantador da pálpebra superior diminui após a cirurgia para a correção da ptose.
PURPOSE: To evaluate the differences between upper eyelid levator muscle function (UELMF), margin reflex distance (MDR1), and eyelid crease height (ECH) before and after ptosis and dermatochalasis surgery. METHODS: Forty-four patients with blepharoptosis and dermatochalasis were enrolled. Intervention: An exploration of the levator tendon (LT) during a blepharoplasty procedure in patients with blepharoptosis and dermatochalasis and in case of its disinsertion, the tendon was reattached to the tarsus. Measured outcome: The differences between UELMF, MDR1, ECH before and after surgery were evaluated bilaterally. Dependency between both eyes was corrected by generalized estimating equations. Pearson correlation was used to evaluate the dependency of the two eyes regarding UELMF, MDR1 and ECH. RESULTS: There was a statistical significant difference between the measures of UELMF before and after surgery with excursion decreasing by a mean value of 1.1 mm after the procedure (P<0.001). Measures of MDR1 showed an increase by a mean of 1.6 mm and ECH decreased by a mean of 3.97 mm (P<0.001). We found a significant correlation between both eyes for all analyzed eyelid variables, both before and after surgery. Correlation before surgery was stronger for the group without previous surgery. The same results for correlation were found for the amount of disinsertion (P>0.001). CONCLUSIONS: Upper eyelid levator muscle function decreases after ptosis surgery.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Blepharoptosis/physiopathology , Eyelids/pathology , Oculomotor Muscles/physiopathology , Blepharoplasty/methods , Blepharoptosis/pathology , Blepharoptosis/surgery , Eyelid Diseases/physiopathology , Eyelid Diseases/surgery , Eyelids/physiopathology , Eyelids/surgery , Oculomotor Muscles/pathology , Oculomotor Muscles/surgery , Treatment Outcome , Tendons/surgeryABSTRACT
Al examinar a un paciente y detectar asimetría facial por ptosis unilateral, es necesario realizar un anamnesis completa y examen físico para dilucidar si se trata de un hecho aislado o es manifestación de un trastorno neuromuscular. A los padres les preocupa además el factor estético de la ptosis por lo cual se debe explicar y estudiar precozmente para mayor tranquilidad.
Subject(s)
Humans , Child , Blinking , Blepharoptosis/congenital , Blepharoptosis/diagnosis , Blepharoptosis/therapy , Blepharoptosis/physiopathology , SyndromeABSTRACT
Apresentamos o caso de uma mulher de 47 anos submetida a obliteração endovascular de um aneurisma gigante de carótida interna cavernosa à esquerda, no qual o balão distal foi inflado, tal como usual, dentro do segmento cavernoso da artéria carótida interna, diferente do proximal, o qual foi inflado dentro do canal carotídeo devido a problemas técnicos. Conseqüentemente, um quadro clínico de neuralgia paratrigeminal de Raeder se instalou. Este é o primeiro relato na literatura com estas características. Uma revisão das vias anatômicas e maiores considerações a respeito de possíveis mecanismos fisiopatológicos envolvidos são apresentados.
Subject(s)
Female , Humans , Middle Aged , Balloon Occlusion/adverse effects , Blepharoptosis/etiology , Carotid Artery, Internal , Intracranial Aneurysm/therapy , Miosis/etiology , Trigeminal Neuralgia/etiology , Blepharoptosis/physiopathology , Cerebral Angiography , Intracranial Aneurysm , Magnetic Resonance Imaging , Miosis/physiopathology , Syndrome , Trigeminal Neuralgia/physiopathologyABSTRACT
Purpose To determine the average and the range of values of the upper lid margin-to-corneal reflex distance [ULCRD] of Saudi Arabian men and to compare them to known values for Saudi Arabian boys and Caucasian men. Such data could be useful in diagnosing and quantifying the degree of ptosis among Saudi men. Methods The subjects [N = 198, 396 eyes] were Saudi Arabian men of Arab origin aged between 16 and 26 years. All were students in secondary and tertiary institutions in the Riyadh area. Measurements of the ULCRD were obtained from projected frontal slide photographs of the subjects taken at a distance of 7m. Measured distances were converted to actual values by multiplying by a constant magnification factor. Results The average values of the ULCRD of the two eyes were similar. The average ULCRD of the right eye of all subjects was 3.49 mm +/- 0.8[range = 1.68 to 5.61 mm]. The average ULCRD asymmetry between the eyes was 0.06 mm +/- 0.48 [range = + 1.0 to -1.0 mm]. Conclusions The average value of the ULCRD of Saudi men is significantly higher than that of Saudi boys, whose average value is 3.05 mm +/- 0.79, but much lower than reported averages for Caucasians [4.5 mm, 4.1mm]. The reasons for the racial differences are not immediately clear because of inadequate demographic data on the Caucasian subjects. ULCRD asymmetry greater than 1.0 mm should be investigated further for evidence of ptosis
Subject(s)
Humans , Male , Blepharoptosis/physiopathology , Cornea/physiology , BlinkingABSTRACT
Los hemangiomas se clasifican según su variedad histológica en capilares, cavernosos, esclerosantes, venosos (racemosos) para las variedades benignas y dentro de éstas existen otras subvariedades que dependen de la respuesta de los tejidos vecinos, como el angioqueratoma, etc. La forma maligna es el angiosarcoma. El hemangioendotelioma y hemangiopericitoma son entidades específicas que constituyen cuadros bien definidos con patrón histológico diferente y comportamiento biológico específico. Cada una de esta entidades tiene un tratamiento específico y el diagnóstico de certeza es histopatológico.
Subject(s)
Sarcoma, Kaposi/physiopathology , Blepharoptosis/physiopathology , Hemangioma, Capillary/physiopathology , Eye Diseases/diagnosis , Hemangioendothelioma/physiopathology , Hemangioma, Cavernous/physiopathology , Angiokeratoma/physiopathology , Hemangiosarcoma/pathology , Neoplasms, Vascular Tissue/etiology , Eyelids/pathologyABSTRACT
Apresentou-se um caso de Síndrome de Marcus Gunn, relacionando a provável etiologia, às diferentes formas de apresentaçäo, bem como às anormalidades oculares associadas. As possibilidades terapêuticas e seus resultados säo discutidos
Subject(s)
Blepharoptosis/physiopathology , Blepharoptosis/surgery , Blepharoptosis/therapyABSTRACT
Two unusual cases of Marcus Gunn phenomenon in adults are presented. The first case was characterised by a bilateral jaw-winking phenomenon along with an asymmetric bilateral congenital ptosis, whereas the second case had bizarre spontaneous movements of the affected lid, deficient abduction and pseudoptosis in association with jaw-winking. The pathogenesis of Marcus Gunn phenomenon is discussed.
Subject(s)
Adolescent , Blepharoptosis/physiopathology , Eyelids/physiopathology , Female , Humans , Jaw/physiopathology , MaleABSTRACT
Os autores apresentam um estudo comparativo entre pacientes de um grupo controle, de um grupo portador de dermatocalase e outro grupo portador de bolsas gordurosas palpebrais. Concluem ser mais provável a ocorrência de ptose palpebral pós-retopexia no pós-operatório de cirurgia de catarata ou glaucoma em pacientes que apresentam bolsas gordurosas palpebrais prévias à cirurgia. (P<0,05)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Blepharoptosis/epidemiology , Eyelid Diseases/physiopathology , Cataract Extraction/adverse effects , Blepharoptosis/physiopathology , Eyelid Diseases/complicationsABSTRACT
Benign intracranial hypertension may occasionally be associated with various cranial nerve palsies. A case with multiple cranial nerve involvement is presented.
Subject(s)
Abducens Nerve/physiopathology , Adult , Blepharoptosis/physiopathology , Facial Nerve/physiopathology , Facial Paralysis/physiopathology , Female , Humans , Pseudotumor Cerebri/complicationsSubject(s)
Blepharoptosis/physiopathology , Blinking , Child , Eyelids/physiopathology , Humans , Jaw/physiology , MaleABSTRACT
Os autores descrevem um caso de ptose palpebral bilateral com paralisia do olhar vertical para cima, predominantemente unilateral, após acidente vascular hemorrágico do tronco encefálico. Outra característica marcante do quadro clínico foi um estado de sonolência que regrediu lentamente. Após revisäo da literatura sobre a fisiopatologia da ptose palpebral e dos movimentos oculares verticais, juntamente com a análise de casos publicados, säo propostas explicaçöes para os aspectos clínicos peculiares do presente caso, sempre relacionadas ao resultado da tomografia computadorizada