Complicações da blefaroplastia superior / Superior eyelid blepharoplasty and complications

A blefaroplastia tem sido realizada com grande frequência devido à valorização da cirurgia estética. As complicações relacionadas a este procedimento são raras. Este relato de caso tem como objetivo enfatizar um tipo de complicação que pode ocorrer. T.J.S.P., 45 anos de idade, sexo feminino, branca, procedente de Botucatu, apresentava dermatocálase bilateral. Optou-se pela realização de blefaroplastia superior bilateral, realizada removendo-se pele e gordura da pálpebra superior. No pós-operatório foi observado ptose palpebral à esquerda. Optou-se pela cirurgia para reinserção do músculo levantador da pálpebra superior à esquerda. Um mês após a reinserção, observou-se retração palpebral superior nos dois olhos. A paciente foi, então, submetida à cirurgia para a correção de retração palpebral por desinserção do músculo de Müller. Dois meses após esta última cirurgia, a paciente apresentava ptose palpebral à direita e piora da retração palpebral à esquerda. Nova cirurgia para correção da retração palpebral foi feita, colocando-se enxerto livre de esclera para alongamento do levantador da pálpebra superior esquerda, com bom resultado. Foi apresentada uma paciente submetida à blefaroplastia e que desenvolveu no pós-operatório quadro de ptose, seguida de retração palpebral. Estes dois quadros podem ocorrer como complicação de blefaroplastia e o cirurgião deve estar atento para manejar de forma apropriada, a fim de obter o resultado que a paciente espera ter.

The blepharoplasty has been performed with great frequency due to the appreciation of aesthetic surgery. The complications related to this procedure are rare. This case report aims to emphasize complications that can occur. T.J.S.P., 45 years old, female, white, resident of Botucatu City, presented dermatocalase bilaterally. We opted to perform upper blepharoplasty bilateral, by removing skin and fat of the upper eyelid. In the postoperative period was observed left eyelid ptosis. We decided to reinsert the levator muscle of the left upper eyelid. One month after the ptosis correction, retraction was observed in both upper eyelid. The patient was then submitted to surgery for the correction of eyelid retraction by disinsertion of the muscle of Muller. Two months after this last surgery, the patient presented right eyelid ptosis and worsening of eyelid retraction to the left. New surgery for correction of the eyelid retraction was made, using free graft sclera for elongation of the left eyelid levator muscle, with good results. The authors presented a patient who underwent a blepharoplasty and developed ptosis in the post-operative period, followed by eyelid retraction. These two possibilities may occur as a complication of blepharoplasty and the surgeon must be careful to handle in an appropriate way, in order to get the result that the patient expects to have.

A Case of Sheehan's Syndrome that Manifested as Bilateral Ptosis

Hypothyroidism can cause a variety of signs and symptoms of the neuromuscular system. However, ptosis in a patient with hypothyroidism is very rare. We report here on a case of central hypothyroidism that was due to Sheehan's syndrome and it manifested as bilateral ptosis in a 51-yr-old woman. She complained of exertional dyspnea and weakness. About 25-yr ago, she had a history of severe postpartum vaginal bleeding. The laboratory studies demonstrated hypopituitarism with secondary hypothyroidism. The ptosis was improved by replacement of thyroid hormone. Hypothyroidism should be considered in the differential diagnosis of patients who manifest with ptosis and that prompt replacement of hormone can lead to a complete recovery.

novel technique of small incision fascia lata harvesting without a faciatome for frontalis suspension procedure

To introduce a small incision technique of fascia lata [FL] harvesting for frontalis suspension blepharoptosis procedure. A skin incision was made in a line between the lateral condyle of the tibia and the anterior superior iliac crest, starting 4- 5 cm above the knee and extending upward 2- 2.5 cm. Approximately 8 cm superior to the first incision, a second skin incision was made with the same length. The FL was dissected from subcutaneous tissue from 1 cm superior to superior border of upper incision to 1 cm inferior to inferior border of lower incision. A 15 mm x 5- 10 mm strip of FL was excised. The fascial defect was left open. Subcutaneous and deep layers were closed with three 4-0 plain catgut sutures and the skin with subcuticular 5-0 prolene sutures. The technique was used in 22 patients from 4 to 47 years of age [Mean: 18.29 +/- 14.20] for 34 frontalis sling procedures. Mean follow-up time was 6.17 +/- 3.21 [3-16] months. Wound hematoma [1/22, 4.5%], wound discharge [2/22, 9%], pain at rest [100%, up to 4 days], pain on walking [20/22, 90%; up to 3 weeks], limping [13/22, 59.1%; up to 7 days] were the main postoperative complications. No significant skin scar was observed and none of the patients needed scar revision. Small incision FL harvesting procedure is a good alternative method when the FL stripper is not available

Factors associated with insensitivity to pyridostigmine therapy in Thai patients with ocular myasthenia gravis.

The objective of this study was to determine factors associated with pyridostigmine therapy in patients with ocular myasthenia gravis (OMG). This retrospective study included eighty-five patients with OMG who have been treated with pyridostigmine. Patients were excluded if they were diagnosed as generalized myasthenia gravis within a month after diagnosis or were treated with other medications. Forty-two patients responded to pyridostigmine and 43 patients did not. There were no significant differences in gender, age, the duration of symptoms before treatment, the dosage of pyridostigmine, and the initial presentations of ptosis or diplopia between the two groups. However, an initial presentation of concurrent ptosis and diplopia and the presence of systemic involvement after follow up were significant factors associated with an insensitivity to pyridostigmine in patients with OMG (p = 0.001 and p = 0.01, respectively). Determining these factors could help predict the pyridostigmine response in patients with OMG.

Ocular myasthenia gravis and auto-immune thyroiditis in children.

A 7-year-old girl presented at a university hospital with ptosis of the left eye. This resolved spontaneously within 4 weeks but then the right eye became similarly affected but responded to prostigmine. Left hypertropia with restriction of the right inferior rectus, mild exophthalmos, non-tender diffuse enlargement of the thyroid, normal thyroid function tests, anti-thyroglobulin, and anti-microsomal antibodies indicated an association of autoimmune thyroiditis and ocular myasthenia. The ptosis was remedied with pyridostigmine and short-course oral prednisolone, but the hypertropia persisted.

A Korean Case of Cornelia de Lange Syndrome

PURPOSE: Cornelia de Lange syndrome is a rare disease showing characteristic facial appearance, developmental delay, growth retardation, low birth weight, skeletal formation anomaly, hirsutism and various ophthalmologic problems. METHODS: We experienced a case of an 18-year-old female with Cornelia de Lange syndrome showing superficial keratitis with entropion, ptosis, high myopia, lacrimal cutaneous fistula and characteristic facial appearance. She was born with low birth weight, operated for cleft palate and diagnosed with ventricular septal defect. In addition, she showed psychological lag and developmental impairment. RESULTS: We performed entropion correction surgery, administered medical therapy for superficial keratitis and prescribed glasses for her myopia. CONCLUSIONS: This is the first case report on the successful correction of entropion with Cornelia de Lange syndrome in Korea.

A Case of Surgical Repair in Strabismus Fixus with Ptosis

Strabismus fixus is very rare and the convergent form is rarely accompanied by blepharoptosis. We successfully treated one patient with high myopia whose convergent strabismus fixus, accompanied by blepharoptosis, became severe after cataract surgery. We report the case with a discussion of its pathology. We performed levator advancement operation, bilateral lateral rectus 11 mm resection, and bilateral medial rectus 8 mm recession. The suture was removed after maintaining temporary traction suture for 6 days. Blepharoptosis was completely corrected by postoperative 2 months. Esodeviation was 15PD, which was not increased compared with immediately after surgery. Satisfactory cosmetic outcome was obtained.

Paralisia dos músculos elevadores de um olho: estudo crítico das opçöes cirúrgicas / Double elevator palsy: an assessment of surgical proceures

Resumo: Introduçäo: A paresia ou paralisia que atinge o reto superior e eo oblíquo inferior do mesmo olho é, também, denominada paralisia dupla de elevadores (PDE). A maioria dos casos requer tratamento e este é cirúrgico na quase totalidade dos pacientes. Säo discutidas as vantagens e desvantagens das diferentes condutas, bem como o modo de distribui-las ao longo do tempo. Quadro clinico: O ângulo de desvio na posiçäo primária é variável. Alguns pacientes têm visäo binocular. O olho afetado pode ser usado para fixaçäo. O paciente pode ter ptose palpebral verdadeira ou pseudo-ptose. Posiçäo viciosa de cabeça pode ser observada. O fenômeno de Bell pode estar preservado ou ausente. O teste das duçöes forçadas é usualmente normal, mas às vezes revela certa limitaçäo na elevaçäo. Etinologia: A maioria dos autores admite uma lesäo supranuclear, atingindo as fibras cruzadas destinadas ao reto superior e as näo-cruzadas que se dirigem ao oblíquo inferior. Pode haver comprometimento do sub-núcleo contralateral do reto superior. Tratamento: A cirurgia convencional, de debilitamento e/ ou reforço de musculos com açäo vertical, é ineficaz. Pode haver comprometimento do sub-núcleo contralateral do reto superior. Tratamento: A cirurgia convencional, de debilitamento e/ ou reforço de músculos com açäo vertical, é ineficaz. A transposiçäo dos retos horizontais para a inserçäo do reto superior é o procediemnto de escolha. Conclusäo: A PDE é um quadro multiforme que responde bem à transposiçäo dos retos horizontais (au)

Fibrose congênita de reto inferior atípica com hipotonia muscular generalizada: relato de um caso / Atipical inferior rectus congenital fibrosis with generalizated muscular hypotonia: case report

O caso descrito apresentava uma hipotropia pouco severa com acuidade visual normal e binocularidade em infra-versäo; além de uma hipotonia muscular generalizada, ao contrário da severa hipotropia e ambliopia encontrada nessa afecçäo. O procedimento cirúrgico levou estes fatos em consideraçäo, tendo-se optado por um retrocesso pequeno do reto inferior para que se corrigisse o torcicolo sem interferir na posiçäo de leitura. Os resultados pós-operatórios foram satisfatórios.

Modificações anatômicas da fenda palpebral após blefaroplastia / Anatomic alterations of the palpebral fissure following blepharoplasty

O presente trabalho apresenta um estudo clínico prospectivo de 39 pacientes submetidos a blefaroplastia estética na 38ª Enfermaria da Santa Casa de Misericórdia do Rio de Janeiro, com o objetivo de determinar as modificações anatômicas da fenda palpebral e sua relação com o aparecimento dos sintomas de "olho seco" no pós-operatório. Para melhor compreensão destas alterações e de suas conseqüencias, os autores descrevem a anatomia da fenda palpebral, a fisiologia do sistema lacrimal e a síndrome de olho seco, ressaltando a importância da história clínica e da avaliação criteriosa da morfologia orbital e periorbital, na identificação de fatores predisponentes no pré-operatório.

Eyelid problems and facial palsy

Facial nerve palsy cnn cause corneal exposure, paralytic ectropion and cosmetic problems. The comeal exposure and lagophlhatmos can lead to corneal scarring and loss of vision. Loss of the lacrimal pump, ectropion and lagophthalmos increase suffering by causing epiphora. The cosmetic defects of lid retraction, lagopthalmos and lower lid ectropion are aggravated by brow ptosis and sometimes by aberrant reinnervation. The anatomy of the orbicularis oculi and the ophthalmic management of facial nerve palsy are discussed

Síndrome da flacidez palpebral / Floppy eyelid syndrome

Este trabalho apresenta um caso de síndrome de flacidez palpebral (Floppy Eyelid Syndrome) unilateral. Esta síndrome caracteriza-se por uma conjuntivite papilar crônica e a existência de uma flacidez da pálpebra superior, juntamente com uma perda da elasticidade do tarso, que se everte facilmente ao ser tracionado para cima, achado fundamental para o diagnóstico. Deve ser feito o diagnóstico diferencial com outras causas de conjuntivites papilares crônicas: ceratoconjuntivite límbica superior, conjuntivite medicamentosa, alérgica, infecciosa crônica, reaçoes por corpo estranho e lentes de contato e neoplasia.

Evaluation of levator resection in management of severe congential ptosis

Thirty five lids of twenty seven patients with severe congenital ptosis were treated by levator resection [transcutaneous approach].Twenty to twenty five mm of the muscle were excised with full correction in 32 cases, overcorrection in 2 cases and undercorrection in one case. Patients were followed up for 12 months levator resection in severe congenital ptosis is recommended before thinking of frontalis sling operations

Concidência de blefaroptose com outras alteraçöes oftalmológicas / Coincidence of blepharoptosis with other aphthalmologic changes

Foram analisados 60 pacientes portadores de blefaroptose que passaram pelo Serviço de Motilidade Extrínseca da Santa Casa de Misericórida de Säo Paulo. Observou-se entre eles uma grande incidência de estrabismo (50%), ambliopia (28,3%) e anisometropia (38,3%)

Esclerosis lateral amiotrófica juvenil asociada a compromiso cócleo-vestibular, atrofia óptica, ptosis palpebral y fatigabilidad muscular / Juvenile amyotrophic lateral sclerosis associated with cocleo-vestibular disturbances, optic atrophy, palpebral ptosis and muscle weakness

Se comunica el caso de un paciente joven portador de un síndrome progresivo, caracterizado por compromiso de la motoneurona, de predominio bulbar, asociado a hipoacusia neurosensorial, disfunción vestibular central, atrofia óptica, ptosis palpebral y elementos cerebelosos. Se discute la nosología de la entidad, estableciéndose semejanzas con la parálisis bulbar en asociación con sordera y atrofia óptica, cuya primera descripción, corresponde a Brown a fines del siglo pasado. Este caso tratado con Nicergolina, y lográndose una mejoría aceptable, sugiere para este grupo de enfermos una definición mórbida distinta a la de otras atrofias espinales, postulándose un origen mitocondrial del daño.

Ptose palpebral bilateral com paralisia unilateral do olhar vertical para cima: registro de caso / Bilateral palpebral ptosis with unilateral paralysis of upward gaze: a case report

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