Blepharoptosis following pterigium excision is a rare complication, and there is no published report on its etiology, incidence, and surgical pathology. We report 4 cases of persistant blepharoptosis following pterigium surgery. The main clinical features are high or absent upper lid crease, thinning of ptotic eyelid above tarsal plate, good levator function, 2-3mm of ptosis degree, abnormal drooping of upper eyelid at downward gaze, and deepening of the upper sulcus. They have a specific anatomic defect in the aponeurosis of levator palpebrae superioris(LPS) muscle. It has been assumed that eyelid speculum leads to injury of upper border of tarsal plate and disinsertion of aponeurosis of LPS muscle in the patient who had vulnerable aponeurosis of LPS muscle during surgery. Disinsertion of aponeurosis of LPS muscle from its epitarsal attachment was discovered during blepharotosis surgery and it was repaired anatomically to correct the blepharoptosis.
Blepharoptosis* ; Eyelids* ; Humans ; Incidence ; Pathology, Surgical ; Pterygium* ; Surgical Instruments*

Kearns-Sayre syndrome, first described by Kearns and Sayre in 1958, is a rare disorder consisting of ptosis, limited movement of both eyes and atypical retinal pigmentary change (salt-pepper like appearance). Most cases have shown an increase in the concentration of mitochondria and ragged-red fiber under Gomori-trichrome staining on muscle biopsy. Occasionally, it is combined with other neurologic and endocrinologic symptoms such as ataxia, dementia, diabetes, and hyperaldosteronism. We recently experienced three cases of male teenaged patients who expressed the clinical features of Kearns-Sayre syndrome.
Adolescent ; Adult ; Atrophy ; Biopsy ; Blepharoptosis/*pathology ; Electrooculography ; Humans ; Kearns-Sayer Syndrome/*pathology ; Male ; Muscle, Skeletal/*pathology ; Ophthalmoscopes ; Retina/*pathology

Myasthenia gravis is a chronic disease characterized by voluntary muscle weakness and fatigue. Myasthenia gravis was first described by Thomas Willis in 1672. The etiology of myasthenia gravis is not clarified but recently it has been suggested that it is an autoimmune disease. Ocular myasthenia gravis is characterized clinically by blepharoptosis and external ophthalmopleia. The illness has a tendency to exacerbation and spontaneous remission. The authors observed a case of severe ocular myasthenia gravis which had developed total external ophthalmoplegia. And we reviewed the literature of recent years related to myasthenia gravis, particulary for its etiology, clinical course, pathology, diagnosi, treatment, and prognosis.
Autoimmune Diseases ; Blepharoptosis ; Chronic Disease ; Fatigue ; Muscle, Skeletal ; Myasthenia Gravis* ; Ophthalmoplegia* ; Pathology ; Prognosis ; Remission, Spontaneous

A 34-year-old female was suffered from pain and numbness of right arm for 2 months after undergoing a thoracoscopic procedure for a posterior mediastinal mass that was diagnosed as neurilemmoma. The patient was diagnosed as a complex regional pain syndrome type 2 with brachial plexopathy developed during thoracoscopic excision of posterior mediastinal mass, and stellate ganglion block (SGB) with 0.2% ropivacaine 10 mL was performed every 3-4 days. The patient revealed slightly prolonged blepharoptosis as Horner syndrome accompanied after every SGB and recovered. However, following the 23rd SGB, the blepharoptosis persisted and patient was recovered spontaneously from blepharoptosis after about 12 months. The possibility that the persistent blepharoptosis might be caused by brachial plexopathy related to patient's pathology or surgical manipulation and/or repeated SGB. If Horner syndrome occurs, its etiology should be assessed, and it would be necessary to explain and to assure the patient the possibility of recovery spontaneously from the complication within a year, without any sequelae.
Adult ; Arm ; Blepharoptosis* ; Brachial Plexus Neuropathies* ; Female ; Horner Syndrome ; Humans ; Hypesthesia ; Neurilemmoma ; Pathology ; Stellate Ganglion* ; Thoracoscopy*

Blepharoptosis is a common indication for surgery in plastic surgery units, yet its possible underlying pathology frequently remains unidentified. A 52-year-old man with a 20-year history of progressive bilateral ptosis (right>left) presented with recurrent ptosis of both eyes; he had undergone an operation on the levator aponeurosis 12 years prior. Due to the suspicion of an underlying disease, he was evaluated further. Chronic progressive external ophthalmoplegia in transition to the more severe syndromic variant Kearns-Sayre syndrome, a mitochondrial disorder causing myopathy, was diagnosed. The patient was treated with coenzyme Q10, and he underwent ptosis surgery on both eyes. This case illustrates a potentially multi-systemic disease that was diagnosed by a further evaluation of a common symptom, in this case worsening blepharoptosis. Awareness of myopathic symptoms is necessary to prevent overlooking serious yet improvable conditions.
Blepharoplasty ; Blepharoptosis* ; Humans ; Kearns-Sayre Syndrome* ; Middle Aged ; Mitochondrial Diseases ; Muscular Diseases ; Ophthalmoplegia, Chronic Progressive External ; Pathology ; Surgery, Plastic

BACKGROUNDBlepharophimosis ptosis epicanthus inversus syndrome (BPES) is a rare congenital ophthalmic disorder, characterized by congenital eyelid malformation including bilateral ptosis, shortening of the horizontal eyelid fissure, epicanthus inversus, and increased distance between the inner canthi. In this research, we studied the histological structure and ultrastructure of medial canthal ligament of patients with BPES.

METHODSThirty patients with BPES who received plastic surgery at the Zhongshan Ophthalmic Center from March 2006 to January 2008 were studied. There were 17 males and 13 females with an average age of (8.73 +/- 3.37) years (3 - 31 years). The medial canthal ligaments of patients were collected during the plastic surgery to analyze the histological structure by hematoxylin and eosin (HE), Congo red, van Gieson's (VG), Masson trichrome and aldehyde-fuchsin staining. The ultrastructures of the medial canthal ligaments were also analyzed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Fifteen samples of medial canthal ligament from healthy persons with an average age of (9.02 +/- 3.12) years (6 - 30 years) were collected as a control group.

RESULTSMorphological and histological study showed that the medial canthal ligaments of BPES patients were composed of collagen fibers, a few elastic fibers and striated muscles. The collagen fibers assemblies were disorganized and the fibrous connective tissues were undergoing hyaline degeneration. The karyopycnosis of fibroblasts was located among the collagen fibrils and the numbers of fibroblasts were decreased. Ultrastructural study with SEM showed that the collagen fibers were larger than normal, irregular and loose. Parts of the collagen fibers were broken and had a coarse surface. Ultrastructural study with TEM showed that the fibroblasts had less cytoplasm, fewer organelles and the nucleus displayed pyknosis.

CONCLUSIONSThe medial canthal ligament in BPES patients is composed chiefly of collagen fibers. The collagen fibers of medial canthal ligaments in BPES patients are disorganized and hyaline degeneration is present. The study revealed that the medial canthal ligament of BPES patients might have congenital dysplasia.

Adolescent ; Adult ; Blepharophimosis ; genetics ; pathology ; Blepharoptosis ; genetics ; pathology ; Child ; Child, Preschool ; Eyelids ; abnormalities ; pathology ; ultrastructure ; Female ; Humans ; Male ; Microscopy, Electron, Scanning ; Microscopy, Electron, Transmission ; Syndrome

PURPOSE: To evaluate the efficacy of porous expanded polytetrafluoroethylene (e-PTFE, Goretex (R) ) containing large pores made with a 21-gauge needle as a graft for the correction of lower lid retraction. METHODS: e-PTFE grafts were implanted between the tarsus and lower lid retractor via a transconjunctival approach with/without amniotic membrane transplantation, or via a transcutaneous approach. Rabbits were examined and assessed for corneal and conjunctival complications and for e-PTFE graft status. Rabbits were sacrificed for a histological study at 8 weeks postoperatively. RESULTS: e-PTFE grafts were uniformly extruded 3 weeks postoperatively in eyelids operated on via the transconjunctival approach. However, rabbits operated on via the transcutaneous approach demonstrated e-PTFE graft retention; in addition, dense fibrovascular ingrowths into the large pores of e-PTFE were observed histologically. CONCLUSIONS: e-PTFE is a good substitute for other graft materials as a spacer in lower lid retraction operations, especially as an interpositional graft using a transcutaneous approach.
Treatment Outcome ; Rabbits ; *Prosthesis Implantation ; Prosthesis Design ; Prostheses and Implants ; *Polytetrafluoroethylene ; Eyelids/pathology/surgery ; Disease Models, Animal ; Blepharoptosis/pathology/*surgery ; Blepharoplasty/*methods ; Biological Dressings ; Animals

The cavernous sinus of skull base is a extremely rare metastastatic site for hepatocellular carcinoma (HCC). A 51-year-old man was diagnosed with HCC by liver biopsy and palliative radiotherapy on HCC including main portal vein was performed. One month later, he was admitted due to sudden onset ptosis. Neurologic findings were normal except for abnormal movement of right eye, and it raised the possibility of abnormality in the right occulomotor, trochlear and the abducens nerves. Contrast-enhanced CT scan of brain showed a mass with homogeneous enhancement involving the right cavernous sinus. T2-weighted axial MR images demonstrated a homogeneous mass with intermediate signal intensity, and contrast-enhanced axial T1-weighted MR images demonstrated a mass with homogeneous enhancement in the right cavernous sinus. We describe a case of HCC metastasis to the cavernous sinus with symptoms of ptosis and disturbance of right eyeball movement.
Blepharoptosis/*etiology/pathology ; Carcinoma, Hepatocellular/complications/*diagnosis/*secondary ; Cavernous Sinus/*pathology ; Humans ; Liver Neoplasms/complications/*pathology ; Male ; Middle Aged ; Ophthalmoplegia/pathology ; Skull Base Neoplasms/diagnosis/*secondary ; Tomography, X-Ray Computed