Eyelid Stretching Exercise Performed in Overcorrection after Levator Resection in Congenital Ptosis

Ka Young Moon; In Cheon You; Min Ahn

doi:10.3341/jkos.2015.56.10.1635

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Moon, You, and Ahn: Eyelid Stretching Exercise Performed in Overcorrection after Levator Resection in Congenital Ptosis

Original Article

J Korean Ophthalmol Soc 2015;56(10):1635-1639.

Published online: 28 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1635

Eyelid Stretching Exercise Performed in Overcorrection after Levator Resection in Congenital Ptosis

Ka Young Moon, M.D¹, In Cheon You, M.D, PhD^1,^2,³, Min Ahn, M.D, PhD^1,^2,^3,

¹Department of Ophthalmology, Chonbuk National University Medical School¹, Jeonju, Korea

²Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea

³Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Korea

Address reprint requests to Min Ahn, MD, PhD Department of Ophthalmology, Chonbuk National University Hospital, #20 Geonji-ro, Deokjin-gu, Jeonju-si, 54907, Korea Tel: 82-63-250-1965, Fax: 82-63-250-1960 E-mail: ahnmin@jbnu.ac.kr

‗ This study was presented as a narration at the 109th Annual Meeting of the Korean Ophthalmological Society in 2013.

‗ This paper was supported by Fund of Biomedical Research Institute, Chonbuk National University Hospital.

Received 19 December 20141 June 2015 Accepted 31 July 2015

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

To report the clinical effect of an eyelid stretching exercise in 8 cases of overcorrected congenital ptosis after levator resection and present a literature review.

Case summary

Eyelid stretching exercise was performed by pushing the margin of the upper eyelid down. If margin reflex dis-tance 1 (MRD1) asymmetry was larger than 1.5 mm compared with the other eyelid after the stretching exercise for 2 weeks, the exercise was extended for 1 more week. This study included 8 eyes of 8 patients who performed eyelid stretching exercise for 2 weeks when overcorrected 1 week after undergoing levator resection. We compared preoperative MRD1 and postoperative MRD1s for 1 month. Overcorrection was corrected satisfactorily in all patients with bilateral symmetry with eyelid stretching ex-ercise for 2 weeks. Additional exercise did not affect MRD1.

Conclusions

In congenital ptosis overcorrected after levator resection, medical treatment including eyelid stretching exercise could be considered before undergoing a secondary operation. Eyelid stretching exercise can be effective when performed early before fibrous tissue bonds are too firm.

Keywords: Congenital ptosis, Eyelid stretching exercise, Levator resection

References

1. Byon IS, Choi HY. Outcomes of anterior levator resection and frontalis sling in congenital ptosis with poor levator function. J Korean Ophthalmol Soc. 2005; 46:1605–10.

2. Callahan MA, Beard C. Beard’s ptosis, 4th ed. Birmingham: Aesculapius Publishing Co.,. 1990; 52–87.

3. Seo SW. Treatment for ptosis. Kim YD, Lee SY, Kim SJ, editors. . Ophthalmic Plastic and Reconstructive Surgery. 2nd. Seoul: Naewaeh-haksool;2009; v. 1. chap. 6.

4. Frueh BR. The mechanistic classification of ptosis. Ophthalmology. 1980; 87:1019–21.

5. Kim MH, Kim HS. Surgical comparative observation of congenital blepharoptosis. J Korean Ophthalmol Soc. 1988; 29:275–81.

6. Göncü T, Çakmak S, Akal A, Karaismailoğ lu E. Improvement in levator function after anterior levator resection for the treatment of congenital ptosis. Ophthal Plast Reconstr Surg. 2015; 31:197–201.

7. Putnam JR, Nunery WR, Tanenbaum M, McCord CD. Blepharoptosis. In: MacCord CD, Tanenbaum M, Nunery WR, eds. Oculoplastic Surgery, 3rd ed. New York: Lippincott Williams & Wilkins,. 1995; 175–220.

8. Fox SA. Surgery of Ptosis (Blepharoptosis), 1st ed. New York: Grune and Stratton,. 1968; 91–111.

9. Lee YJ. Principles of ophthalmic plastic and reconstructive surgery. Kim YD, Lee SY, Kim SJ, editors. . Ophthalmic Plastic and Reconstructive Surgery. 2nd. Seoul: Naewaehs;2009. v. 1. chap. 2.

10. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin North Am. 2005; 38:921–46.

Figure 1.

Photograph showing eyelid stretching exercise.

Figure 2.

Photographs of patient 1 (1A-1C), 2 (2A-2C), 3 (3A-3C) and 4 (4A-4C). (1A, 2A, 3A, 4A) Before the operation of levator resection. (1B, 2B, 3B, 4B) One week after the operation. (1C, 2C, 3C, 4C) Final postoperative appearance after eyelid stretching exercise for two or three weeks.

Figure 3.

Photographs of patient 5 (1A-1C), 6 (2A-2C), 7 (3A-3C) and 8 (4A-4C). (1A, 2A, 3A, 4A) Before the operation of levator resection. (1B, 2B, 3B, 4B) One week after the operation. (1C, 2C, 3C, 4C) Final postoperative appearance after eyelid stretching exercise for two or three weeks.

Table 1.

Summary of cases

	Sex	Age (years)	MRD1 (mm)1st week	Asymmetry (mm)			MRD1 changes (mm)	Reoperaion	Result
	Sex	Age (years)	MRD1 (mm)1st week	1st week	3rd week	4th week	MRD1 changes (mm)	Reoperaion	Result
1	M	13	7.0	5.0	0.0	0.0	4.5	No	Excellent
2	F	5	6.5	4.5	0.0	0.0	3.5	No	Excellent
3	F	40	4.5	2.5	2.0	2.0	0.5	No	Good
4	F	3	7.0	6.0	1.5	1.5	3.5	No	Good
5	F	11	5.0	2.0	1.0	1.0	1.0	No	Excellent
6	M	5	4.0	2.0	0.0	0.0	2.0	No	Excellent
7	F	56	7.0	3.0	1.5	1.5	4.0	No	Good
8	M	3	5.0	2.0	0.0	0.0	2.0	No	Excellent
Average		17	5.8	3.4	0.8	0.8	2.6

MRD1 = margin reflex distance 1; M = male; F = female.

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