Postoperative Neurogenic Blepharoptosis after Repair of a Medial Orbital Wall Fracture Using the Transcaruncular Approach

Seong-Kwang Ryu; Min Ahn

doi:10.3341/jkos.2011.52.5.624

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Ryu and Ahn: Postoperative Neurogenic Blepharoptosis after Repair of a Medial Orbital Wall Fracture Using the Transcaruncular Approach

Original Article

J Korean Ophthalmol Soc 2011;52(5):624-627.

Published online: 3 August 2011

DOI: https://doi.org/10.3341/jkos.2011.52.5.624

Postoperative Neurogenic Blepharoptosis after Repair of a Medial Orbital Wall Fracture Using the Transcaruncular Approach

Seong-Kwang Ryu, MD, Min Ahn, MD

Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea

Address reprint requests to Min Ahn, MD Department of Ophthalmology, Chonbuk National University Hospital San 2-20 Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea Tel: 82-63-250-1878, Fax: 82-63-250-1960, E-mail: ahnmin@jbnu.ac.kr

Received 18 October 201011 November 2010 Accepted 8 March 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We report a case of neurogenic blepharoptosis after reconstruction of a medial orbital wall fracture using the transcaruncular approach.

Case summary

A 13-year-old girl presented with left eyeball pain and binocular diplopia caused by trauma from falling. Orbital computerized tomography showed a blowout fracture of the left medial orbital wall, herniation of the orbital soft tissue into the ethmoid sinus, and a portion of the medial rectus muscle trapped in the fracture. The patient underwent suc-cessful reconstruction of the medial orbital wall using the transcaruncular approach. However, moderate blepharoptosis with functional loss of the levator palpebrae superioris muscle developed immediately after awaking from the anesthesia. The blepharoptosis was presumed to have developed due to postoperative edema; therefore, oral corticosteroid was prescribed. However, the blepharoptosis did not improve. No other ocular signs or symptoms were detected. Because nei-ther the margin reflex distance (MRD1) nor the function of the levator palpebrae superioris muscle recovered after eight weeks of conservative treatment, surgical correction of blepharoptosis was performed under local anesthesia. The pre-aponeurotic fat, soft tissue, tarsal plate, and aponeurosis of the levator palpebrae superioris all appeared normal. The patient underwent maximal resection of the levator palpebrae superioris muscle and the blepharoptosis was alleviated two weeks after the operation.

Keywords: Blepharoptosis, Caruncle, Oculomotor motor, Orbital wall reconstruction

References

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Figure 1.

Axial (A) and coronal (B) orbital CT scans showing a blowout fracture of the left medial orbital wall.

Figure 2.

Postopertive blepharoptosis of the left eyelid 1day after reconstruction of medial orbital wall fracture via transcaruncular approach (A). Normal appearance of tarsal plate and levator aponeurosis during ptosis operation (B). Complete improvement of ptosis on the left upper eyelid after maximal levator resection (C).

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