J Korean Ophthalmol Soc.  2014 Aug;55(8):1261-1265.

A Case of Complete Recovery of Isolated Neurogenic Ptosis after Trauma

• Yeom MI
• Kim SS
• Lee CK

Abstract

PURPOSE
To report a rare case of isolated neurogenic blepharoptosis secondary to eyelid trauma.
CASE SUMMARY
A previously healthy 41-year-old male was evaluated for decreased visual acuity and blepharoptosis in the left eye after ocular trauma. On ophthalmologic examination, visual acuity in the left eye was hand motion, intraocular pressure was 29 mm Hg, hematoma and eyelid edema were minimal. The patient had complete unilateral ptosis with superficial upper eyelid laceration. Additional findings in the left eye included fracture of the medial orbital wall, hyphema, iris sphincter muscle tear, iridodialysis and conjunctival laceration. The other examinations were unremarkable with full ocular motility. Because of iris sphincter muscle tear and iridodialysis, the pupillary reaction could not be evaluated. His left upper eyelid drooped completely and levator function test (LFT) was 0 mm. He was diagnosed with an isolated neurogenic blepharoptosis and received oral prednisolone at a dose of 1 mg/kg per day for 7 days with gradual tapering. One month later, the patient had normal symmetric lid height and completely restored levator function.

Keyword

Isolated neurogenic ptosis; Oculomotor nerve

MeSH Terms

Adult
Blepharoptosis
Edema
Eyelids
Hand
Hematoma
Humans
Hyphema
Intraocular Pressure
Iris
Lacerations
Male
Oculomotor Nerve
Orbit
Prednisolone
Visual Acuity
Prednisolone

Figure

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  Figure 1. Left upper eyelid ptosis after trauma. Complete ptosis with minimal eyelid edema were noted.

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  Figure 2. Photographs show no limitations of extraocular muscles at 9 cardinal gazes were observed at 1 day. Especially preservation of superior rectus muscle functions were noted.

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  Figure 3. Hyphema grade 1, iridodialysis, iris sphincter tear were observed at 1 day.

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  Figure 4. Medial orbital wall fractures with fat herniation of the left eye were shown on the preoperative CT. There was no evidence of orbital apex syndrome and minimal eyelid edema. (A) Transverse view. (B) Sagittal view.

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  Figure 5. Complete recovery to normal lid position was observed at 1 month after trauma.

Reference

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