J Korean Ophthalmol Soc.  2011 Sep;52(9):1099-1103.

Temporary Severe Neurogenic Blepharoptosis after Reconstruction of Orbital Medial Wall Fracture

• Jung SK
• Choi JA
• La TY

Abstract

PURPOSE
To report two cases of temporary severe neurogenic blepharoptosis after successful reconstruction of orbital medial wall fracture.
CASE SUMMARY
A 36-year-old woman and a 52-year-old man received orbital medial wall reconstruction with Medpor(R) for large fractures. Before the operation, the patients had only moderate swelling of the lid and periorbital ecchymosis. There were no limitations of extraocular muscles or ptosis. The operations were successful, although the patients developed unilateral complete ptosis with totally impaired levetor muscle function immediately after recovering from anesthesia. There were no anisocoria or limitations of the extraocular muscles. After oral steroid therapy, the patients began to improve on postoperative day 4 and after one month, respectively, and recovered to normal lid height and levator function after two months.
CONCLUSIONS
Blepharoptosis after orbital medial wall reconstruction may result from ischemic damage at the end of the superior branch of the oculomotor nerve in the orbit due to compressive and tractional manipulation. Although very rare and temporary, this complication should be considered important because the occurrence can be unpredictable and may cause dissatisfaction to the surgeon and the patient after a successful operation.

Keyword

Neurogenic blepharoptosis; Oral steroid; Orbital medial wall fracture

MeSH Terms

Adult
Anesthesia
Anisocoria
Blepharoptosis
Ecchymosis
Female
Humans
Middle Aged
Muscles
Oculomotor Nerve
Orbit
Traction

Figure

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  Figure 1. Large medial orbital wall fractures of the left eye are shown on the preoperative CT. (A) Coronal view of Case 1 patient. (B) Transverse view of Case 2 patient. (C) Coronal view of Case 1 patient. (D) Transverse view of Case 2 patient.

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  Figure 2. (A, B) Photographs show complete ptosis of the left eye at postoperative 1 day. (C, D) No limitations of extraocular muscles at 9 cardinal gazes were observed at postoperative 1 day. Especially preservation of superior rectus muscles functions are noted. (A, C) Case 1 patient. (B, D) Case 2 patient.

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  Figure 3. Recovery to normal lid positions are observed at postoperative 2 months. (A) Case 1 patient. (B) Case 2 patient.

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  Figure 4. Lateral view of the course of the third cranial nerve. Reprinted from Foroozan et al,8 copyright 2004, with permission from Elsevier.

Reference

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