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1. Types of materials for frontalis sling surgery for congenital ptosis. Full Text available with Trip Pro

Types of materials for frontalis sling surgery for congenital ptosis. Congenital ptosis is a drooping of one or both eyelids at birth, often due to poor development of the levator palpebrae superioris muscle. This can result in amblyopia, astigmatism, and ocular torticollis and therefore may necessitate surgical intervention in early childhood if visual development is compromised. Patients may have varied levels of levator function. Those with moderate to good function may elect to first (...) attempt ptosis repair with external levator advancement or mullerectomy/Fasanella-Servat procedures. For those with poor function, those procedures are less likely to be effective, so they may undergo frontalis sling surgery, in which the tarsal plate is coupled to the frontalis muscle, so that movement of the brow and forehead result in movement of the eyelid. The optimal material to use in this surgery is unknown.To evaluate the comparative effectiveness and safety of various materials used

2019 Cochrane

2. Assessment of ptosis

Assessment of ptosis Assessment of ptosis - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Assessment of ptosis Last reviewed: February 2019 Last updated: June 2018 Summary Blepharoptosis, or ptosis, refers to the drooping or downward displacement of the upper eyelid. The levator muscle, its aponeurosis, and the Muller muscle are responsible for upper eyelid resting position and elevation. When these structures (...) are compromised, the resultant depressed eyelid position can reduce the amount of light entering the eye, thereby degrading visual acuity (VA). In pseudoptosis, aberrant structural relationships of the intact globe, bony, and soft-tissue attachments may cause secondary eyelid abnormalities. Congenital myogenic, acquired aponeurotic, and involutional forms of ptosis represent the most common causes of ptosis among children and adults. Thakker MM, Rubin PA. Mechanisms of acquired blepharoptosis. Ophthalmol Clin

2018 BMJ Best Practice

3. Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis Full Text available with Trip Pro

Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis Reduction mammaplasty in huge breasts poses a great challenge for plastic surgeons. The classic technique is free nipple and areola grafting after breast amputation. This paper is a short technical report of reduction mammoplasty on 40 patients with severe breast ptosis (suprasternal notch to nipple >35 cm) and giganticomastia (anticipated resection of more than 1 kg per breast) were

2018 Electronic physician

4. Trigeminal hypertrophic interstitial neuropathy presenting as unilateral proptosis, ptosis, tearing, and facial neuralgia Full Text available with Trip Pro

Trigeminal hypertrophic interstitial neuropathy presenting as unilateral proptosis, ptosis, tearing, and facial neuralgia To show the utility of MRI and histology in diagnosing rare cases of trigeminal hypertrophic interstitial neuropathy (HIN).A 57-year-old African-American woman presented with a 4-year history of right eye proptosis with tearing, headaches, and worsening right-sided trigeminal neuralgia symptoms and jaw pain. HIV and diabetes tests were negative and thyroid function

2018 American journal of ophthalmology case reports

5. Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma Full Text available with Trip Pro

Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma To highlight the presentation and management of a patient with eyelid, orbital and nasopharyngeal silicone oil migration through a glaucoma drainage implant presenting as pseudo-xanthelasma and ptosis.A 68-year male presented with unilateral ptosis and presumed xanthelasma. He had a history of glaucoma drainage implant surgery, pseudophakia, and multiple retinal detachment repairs with silicone (...) oil. During ptosis repair it was discovered that his presumed xanthelasma was in fact an eyelid silicone granuloma. Additional work up revealed silicone infiltration of the eyelids, orbits, and nasopharynx, resulting from emulsified silicone oil leakage through his glaucoma valve implant.Silicone oil may emulsify with time, with potential egress via a glaucoma filtration device. Clinicians should be alert for eyelid, orbital and sinonasal findings that may indicate occult migration.

2018 American journal of ophthalmology case reports

6. Isolated left upper eyelid ptosis with pansinusitis and contralateral otitis media in a 9-year-old boy Full Text available with Trip Pro

Isolated left upper eyelid ptosis with pansinusitis and contralateral otitis media in a 9-year-old boy Upper eyelid ptosis has different etiologies in children and adults. In children, the common causes include orbital cellulitis, congenital ptosis, Cranial Nerve (CN) III palsy, and Horner's syndrome. The purpose of this report is to discuss an unusual presentation of ptosis.We describe a case of a 9-year-old boy with left-sided ptosis with no apparent clinical signs of orbital or preseptal (...) infection. Magnetic resonance imaging (MRI) revealed pansinusitis and contralateral otitis media with direct extension into the superior aspect of the left orbit affecting the levator palpebrae superioris muscle.This finding on imaging disclosed the etiology of an otherwise unexplained case of upper lid ptosis.

2018 American journal of ophthalmology case reports

7. Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis. Full Text available with Trip Pro

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis. External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies.To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic (...) ptosis with good levator function.This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic.The technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress

2017 JAMA facial plastic surgery

8. Association of Oxymetazoline Hydrochloride, 0.1%, Solution Administration With Visual Field in Acquired Ptosis: A Pooled Analysis of 2 Randomized Clinical Trials. Full Text available with Trip Pro

Association of Oxymetazoline Hydrochloride, 0.1%, Solution Administration With Visual Field in Acquired Ptosis: A Pooled Analysis of 2 Randomized Clinical Trials. Treatment of acquired blepharoptosis (ptosis) is currently limited to surgical intervention.To examine the efficacy and safety of oxymetazoline hydrochloride, 0.1%, ophthalmic solution (oxymetazoline, 0.1%) in participants with acquired ptosis.This pooled analysis of 2 randomized, double-masked, placebo-controlled, multicenter phase 3 (...) clinical trials included participants 9 years and older with acquired ptosis and superior visual field deficit. The 2 studies were conducted across 16 and 27 sites in the United States. Patients were enrolled from May 2015 to April 2019. Analyses for the individual trials were initiated after database lock and completed on September 6, 2017, and May 16, 2019. Pooled analysis was completed on August 25, 2019.Participants (randomized 2:1) received oxymetazoline, 0.1%, or vehicle, self-administered

2020 JAMA ophthalmology

9. Histological findings of levator muscle in unilateral congenital ptosis in different age groups. (Abstract)

Histological findings of levator muscle in unilateral congenital ptosis in different age groups. To evaluate the different degree of muscle atrophy in specimens of levator muscle of patients operated on for unilateral congenital ptosis, as related to the age of the patient.Histological analysis of the specimen of the levator muscle of 29 patients who underwent a unilateral levator muscle resection under the care of one surgeon was performed. The study population was divided into two different (...) striated muscle fibres separated by thick fibrous septa including cells with centralization of nuclei, hyalinization of cytoplasm (Masson's trichrome stain) and fatty infiltration.Myofibres found in specimens of levator muscle following levator resection for congenital ptosis show characteristics of a degenerative process. This study seems to demonstrate that atrophy in the levator muscle appears to be related to the age of the patient at surgery, as atrophy tends to be more evident in older children

2020 Acta ophthalmologica

10. Premature ovarian insufficiency as a variable feature of blepharophimosis, ptosis, and epicanthus inversus syndrome associated with c.223C > T p.(Leu75Phe) FOXL2 mutation: a case report. Full Text available with Trip Pro

Premature ovarian insufficiency as a variable feature of blepharophimosis, ptosis, and epicanthus inversus syndrome associated with c.223C > T p.(Leu75Phe) FOXL2 mutation: a case report. FOXL2 gene mutations cause blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) and may be associated with premature ovarian insufficiency (POI). Two types of BPES were described in the literature. BPES type 2 is a simple association of inherited developmental defects of the eyelid area, while in type

2019 BMC Medical Genetics

11. Medial renal ptosis: First radiographic documentation with computed tomography. (Abstract)

Medial renal ptosis: First radiographic documentation with computed tomography. Medial renal ptosis is the abnormal mobility of the kidney towards or across the midline of the body. Historically, this phenomenon is evaluated by observing abnormal mobility in the lateral decubitus position during intravenous pyelography. Here, we present the first radiographic documentation of this anomaly on computed tomography on a 34-year-old female who experienced an intermittent abdominal bulge over her

2019 Urology

12. Isolated complete unilateral ptosis with intact extraocular eye movements. (Abstract)

Isolated complete unilateral ptosis with intact extraocular eye movements. An 88-year-old woman presented with a 2-day history of inability to open her left eye with no ocular discomfort or blurred vision. She had a long-standing history of diabetes mellitus, hypertension and stroke disease. Examination revealed an isolated complete left eye ptosis with no pupillary involvement and intact extraocular movements. There were no other neurological deficits and fatigability was not elicited

2019 Age and ageing

13. Hydrocephalus due to aqueductal stenosis presenting with acute bilateral ptosis: case report. (Abstract)

Hydrocephalus due to aqueductal stenosis presenting with acute bilateral ptosis: case report. Hydrocephalus may cause Parinaud's syndrome which consists of vertical gaze palsy, convergence palsy, lid retraction and pupil light-near dissociation. We are aware of only two prior reports of hydrocephalus presenting with bilateral ptosis. Both were cured by ventriculoperitoneal shunts. We report a 28-month-old girl who presented acute bilateral ptosis but full eye movements both sides. Neuroimages (...) revealed chronic hydrocephalus and aqueductal stenosis. The bilateral ptosis resolved quickly after endoscopic third ventriculostomy (ETV).

2019 British Journal of Neurosurgery

14. A Technique for the Prevention of Recurrent Eyebrow Ptosis After Brow Lift Surgery. (Abstract)

A Technique for the Prevention of Recurrent Eyebrow Ptosis After Brow Lift Surgery. Preventing the recurrence of eyebrow ptosis after brow lift surgery is challenging. We developed a novel technique to maintain elevation of the eyebrow after brow lift surgery.A consecutive sample of patients who underwent brow lift surgery between June 2014 and June 2016 was divided into 2 groups. Group A underwent resection of excess skin during brow lift surgery; group B underwent the new eyebrow lift (...) significantly more satisfied with their surgery than patients in group A.Our novel technique is simple and effective for preventing recurrent eyebrow ptosis after brow lift surgery.

2018 Annals of plastic surgery Controlled trial quality: uncertain

15. Tangent screen perimetry in the evaluation of visual field defects associated with ptosis and dermatochalasis. Full Text available with Trip Pro

Tangent screen perimetry in the evaluation of visual field defects associated with ptosis and dermatochalasis. To determine if tangent visual fields gathered during assessment of superior visual field deficits caused by blepharoptosis and dermatochalasis offer good correlation to clinical exam in a time and cost efficient manner.Prospective, observational case series. Subjects included all patients referred to a single surgeon (CCN) who underwent surgical correction of blepharoptosis (...) under the curve showed excellent correlation (r = 0.87). Patients with ptosis showed strong correlation between margin-to-reflex distance and superior visual fields. Patients completed field testing faster than reported times for automated or Goldmann testing. Finally, tangent screens were the least expensive type of equipment to purchase.Tangent visual fields are a rapid and inexpensive way to test for functional loss of superior visual field in patients with upper eyelid malposition. Our data

2017 PLoS ONE

16. A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease. Full Text available with Trip Pro

A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease. The current study aims to summarize breast anthropomorphic measurement features in Chinese patients with breast diseases and to investigate their potential correlations with demographic factors.Fifteen breast anthropomorphic parameters of 605 Chinese female patients were collected prospectively. Breast ptosis status was scaled by two methods and breast (...) volume was calculated according to a modified formula of BREAST-V.Among 1210 breasts, the average breast volume was 340.0±109.1 ml (91.8-919.2 ml). The distance from the nipple to the inframammary fold was 7.5±1.6 cm in the standing position. The width of the breast base was 14.3±1.4 cm (8.5-23.5 cm). The incidence of breast ptosis was 22.8% (274/1204), of which 37 (23.5%) and 79 (31.7%) women had severe ptosis assessed by different criteria. Increased height (OR[odds ratio] = 1.500, P<0.001), post

2017 PLoS ONE

17. Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis. Full Text available with Trip Pro

Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis. Silicone rod is a commonly used synthetic suspension material in frontalis suspension surgery to correct blepharoptosis. The most challenging problem and a decisive drawback of the use of silicone rod is a considerable rate of ptosis recurrence after surgery. We examined patients with recurred ptosis and assessed the physical and micromorphological properties of implanted silicone rods (...) to determine the causative mechanisms of recurred ptosis after frontalis suspension using silicone rod.This is a prospective observational case series of 22 pediatric patients with recurred ptosis after frontalis suspension using silicone rods for congenital ptosis. Implanted silicone rods were observed and removed during the operation for correction of recurred ptosis. The removed silicone rods were physically and micromorphologically evaluated to determine the cause of recurrence.Pretarsal fixation

2017 PLoS ONE

18. Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis. Full Text available with Trip Pro

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis. Twenty-six patients with ptosis related to Myasthenia gravis (MG) and 38 controls with ptosis other than MG were included. All patients were tested with the ice test 2 times on separate days in the afternoon. The margin reflex distance (MRD) was measured before and immediately after 2-minute application of ice on the eyelids. The ice test was judged positive if there was an improvement of at least 2.0 mm (...) of MRD after the ice test. Among the patients with negative test results, 'equivocal' was defined by improvement of MRD from at least 1.0 mm to less than 2.0 mm after the ice test. Repeated ice test results showed an agreement of 61.5% in MG, and 97.4% in nonmyasthenic ptosis. Repeated ice tests increased the sensitivity by 34.6% compared to a single test. Among the patients with repeatedly negative test results, 63.6% of those who showed equivocal results at least once turned out to be MG. Of those

2017 PLoS ONE

19. Ptosis in childhood: A clinical sign of several disorders: Case series reports and literature review. Full Text available with Trip Pro

Ptosis in childhood: A clinical sign of several disorders: Case series reports and literature review. Blepharoptosis (ptosis) is a common but often overlooked sign that may serve as a sign/manifestation of other conditions, ranging from a mild and purely cosmetic presentation to a severe and occasionally progressive disorder. Ptosis may show an acute onset or may manifest as a chronic disorder. Its presentation may vary: unilateral versus bilateral, progressive versus non-progressive, isolated (...) versus complex which occurs in association with other symptoms, and congenital versus acquired (often concomitant with neuromuscular disorders).Congenital ptosis includes the isolated type-the congenital cranial dysinnervation disorders, which are further, distinguished into different subtypes such as Horner syndrome (HS), and ptosis as a sign/manifestation of various congenital malformation syndromes.In this article, we review the primary causes of ptosis occurring in childhood, and its various

2018 Medicine

20. Current management of childhood ptosis. (Abstract)

Current management of childhood ptosis. Blepharoptosis is a common problem encountered in the pediatric ophthalmology clinic. The presentation is obvious to both parents and referring physicians and often prompts urgent consultation. The current classification and management of childhood ptosis will be reviewed.Recent refinements in techniques utilizing new materials hold promise for better, more predictable outcomes and improved long-term results. Autogenous tensor tendon fascia lata harvested (...) from the patient's thigh remains the gold standard for many ptosis surgeons in frontalis suspension; however, other materials are commonly utilized, including silicone rod, Gore-Tex (ePTFE; W.L. Gore & Associates, Flagstaff, Arizona, USA), Mersilene polyester fiber mesh and Ethibond braided polyester (Ethicon US LLC, Somerville, New Jersey, USA), Supramid monofilament nylon (S. Jackson, Inc, Alexandria, Virginia, USA), prolene, and banked fascia lata. Other techniques include levator resection

2018 Current Opinion in Ophthalmology

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