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Ptosis

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1. Types of materials for frontalis sling surgery for congenital ptosis. (PubMed)

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. Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis. (PubMed)

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

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2017 JAMA facial plastic surgery

4. Isolated left upper eyelid ptosis with pansinusitis and contralateral otitis media in a 9-year-old boy (PubMed)

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.

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2018 American journal of ophthalmology case reports

5. Orbital, eyelid, and nasopharyngeal silicone oil granuloma presenting as ptosis & pseudo-xanthelasma (PubMed)

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.

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2018 American journal of ophthalmology case reports

6. Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis (PubMed)

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

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2018 Electronic physician

7. Trigeminal hypertrophic interstitial neuropathy presenting as unilateral proptosis, ptosis, tearing, and facial neuralgia (PubMed)

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

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2018 American journal of ophthalmology case reports

8. Medial renal ptosis: First radiographic documentation with computed tomography. (PubMed)

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

9. Isolated complete unilateral ptosis with intact extraocular eye movements. (PubMed)

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

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2019 Age and ageing

10. Analysis of the causes of recurrence after frontalis suspension using silicone rods for congenital ptosis. (PubMed)

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

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2017 PLoS ONE

11. A prospective study of breast anthropomorphic measurements, volume and ptosis in 605 Asian patients with breast cancer or benign breast disease. (PubMed)

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

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2017 PLoS ONE

12. Tangent screen perimetry in the evaluation of visual field defects associated with ptosis and dermatochalasis. (PubMed)

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

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2017 PLoS ONE

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

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

14. Use of Botulinum Toxin for the Correction of Mild Ptosis (PubMed)

Use of Botulinum Toxin for the Correction of Mild Ptosis Background: Lid margin asymmetry and its associated compensatory mechanisms might cause patients to seek treatment to improve aesthetics. Surgery might not be indicated and can potentially worsen the asymmetry in these cases. Methods: A case series of three patients was organized to illustrate the use of botulinum toxin administered to the pre-tarsal orbicularis for the correction of micro-ptosis and improved symmetry. The marginal reflex

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2018 The Journal of clinical and aesthetic dermatology

15. Amblyopia, Strabismus and Refractive Errors in Congenital Ptosis: a systematic review and meta-analysis (PubMed)

Amblyopia, Strabismus and Refractive Errors in Congenital Ptosis: a systematic review and meta-analysis Congenital ptosis may be associated with abnormalities of visual development and function, including amblyopia, strabismus and refractive errors. However, the prevalence estimates of these abnormalities vary widely. We performed a systematic review and meta-analysis to estimate the prevalence of amblyopia, strabismus and refractive errors in congenital ptosis. Cochrane, Pubmed, Medline (...) %CI 3.0-69.8%), followed by 22.7% (95%CI 18.5-27.8%) for amblyopia, 22.2% (95%CI 7.8-63.1%) for astigmatism, 19.6% (95%CI 16.5-23.2%) for strabismus, 17.3% (95% CI 13.1-22.9%) for anisometropia and 4.0% for hyperopia (95%CI 1.8-7.1%). Significant heterogeneity was identified across most estimates. Our findings suggest that amblyopia, strabismus and refractive errors in congenital ptosis are present in much higher percentage. This study highlights the importance of early diagnosis and timely

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2018 Scientific reports

16. Closed Posterior Levator Advancement in Severe Ptosis (PubMed)

Closed Posterior Levator Advancement in Severe Ptosis Repair of blepharoptosis from the posterior eyelid approach has usually been done utilizing a Müller's muscle-conjuctival resection (MMCR) or an "open sky" technique. We present a new technique to advance the levator muscle from the posterior-approach in a closed fashion that can be used in patients with severe involutional ptosis.A retrospective chart review was performed for consecutive patients with severe involutional blepharoptosis (...) rates.Three hundred three eyes from 192 patients, with severe ptosis were identified. The average age was 65 years, and the mean preoperative MRD1 was 0.3 mm. Postoperatively, mean MRD1 was 3.5 mm with a median improvement of 3.2 mm. The upper eyelid contour was deemed to be satisfactory by patient and surgeon in 98.3% of eyes. Intereye symmetry was excellent in 96% of our cohort. An overall revision rate of 1.8% was found.We present a new technique that involves an advancement of the levator muscle

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2018 Plastic and Reconstructive Surgery Global Open

17. Genomic Disruption of FOXL2 in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Type 2: A Novel Deletion-Insertion Compound Mutation (PubMed)

Genomic Disruption of FOXL2 in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Type 2: A Novel Deletion-Insertion Compound Mutation 30246734 2019 03 21 2542-5641 131 19 2018 10 05 Chinese medical journal Chin. Med. J. Genomic Disruption of FOXL2 in Blepharophimosis-Ptosis-Epicanthus Inversus Syndrome Type 2: A Novel Deletion-Insertion Compound Mutation. 2380-2383 10.4103/0366-6999.241818 Niu Bei-Bei BB Scientific Research Center, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University

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2018 Chinese medical journal

18. Current management of childhood ptosis. (PubMed)

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

19. Intraoperative lagophthalmos formula for levator resection in congenital ptosis. (PubMed)

Intraoperative lagophthalmos formula for levator resection in congenital ptosis. To calculate a regression formula for intraoperative lagophthalmos to determine the amount of correction in levator resection for mild to moderate congenital ptosis.This retrospective study included 38 eyelids from 28 consecutive children with congenital ptosis with levator function of 4 mm or better who showed satisfactory surgical outcomes defined as postoperative margin reflex distance-1 (MRD1) ≥3 mm in each eye (...) in a stronger correlation than either variable alone. Surgeons would be able to calculate the amount of surgical correction using this formula of intraoperative lagophthalmos, which could lead to a satisfactory surgical outcome in levator resection for congenital ptosis.© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

2018 British Journal of Ophthalmology

20. Functional study on new FOXL2 mutations found in Chinese patients with blepharophimosis, ptosis, epicanthus inversus syndrome. (PubMed)

Functional study on new FOXL2 mutations found in Chinese patients with blepharophimosis, ptosis, epicanthus inversus syndrome. Blepharophimosis, ptosis, epicanthus inversus syndrome (BPES) is a rare inheritable disease that mainly affects eyelid development associated with (type I) or without (type II) ovarian dysfunction, resulting in premature ovarian failure (POF). Mutations in the gene forkhead box L2 (FOXL2) have been shown to be responsible for BPES. The aim of this study was to determine

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2018 BMC Medical Genetics

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