Uddin Jimmy M, Rose Geoffrey E
Orbital Service, Moorfields Eye Hospital, City Road, London EC1V 2PD, England, UK.
Ophthalmology. 2003 Jul;110(7):1433-6. doi: 10.1016/S0161-6420(03)00457-3.
To highlight, in patients with adult-onset ptosis, the importance of upper eyelid hang-up during downgaze as a clinical sign of serious orbital disease.
Retrospective, observational case series.
Retrospective review of the presenting clinical symptoms and signs for a series of seven patients, some referred for treatment of adult-onset ptosis, with hang-up of the upper eyelid on down-gaze.
All patients had symptoms of upper eyelid ptosis at presentation, starting at ages ranging from 29 to 81 years (mean, 64 years; median, 70 years). All patients displayed marked hang-up of the affected upper lid on downgaze, and the levator excursion was reduced (range, 2-13 mm; mean, 9 mm) compared with the asymptomatic side. All patients with downgaze hang-up had associated orbital malignancy, but they otherwise had only minimal or no underlying orbital disease. Exophthalmometry varied between subtle (1 mm) relative enophthalmos in two cases, to mild relative proptosis (3/7 cases; range, 2-3 mm). Ipsilateral up gaze was reduced in 4 of 7 patients (57%).
In contrast to patients with adult-onset blepharoptosis (resulting from dehiscence of the levator muscle aponeurosis), adults presenting with ptosis resulting from malignant infiltration of the upper orbital tissues may display hang-up of the upper eyelid in downgaze. This important sign should alert the clinician to the possibility of serious underlying orbital disease.
强调在成人起病性上睑下垂患者中，向下注视时上睑挂滞作为严重眼眶疾病临床体征的重要性。
回顾性观察病例系列。
回顾性分析系列7例患者的临床症状和体征，部分患者因成人起病性上睑下垂伴向下注视时上睑挂滞前来就诊。
所有患者就诊时均有上睑下垂症状，起病年龄在29至81岁之间（平均64岁；中位数70岁）。所有患者向下注视时患侧上睑均有明显挂滞，与无症状侧相比，提上睑肌活动度降低（范围2 - 13毫米；平均9毫米）。所有向下注视时上睑挂滞的患者均伴有眼眶恶性肿瘤，但其他方面仅有轻微或无潜在眼眶疾病。眼球突出度测量结果各异，2例有轻微（1毫米）相对性眼球内陷，3/7例有轻度相对性眼球突出（范围2 - 3毫米）。7例患者中有4例（57%）患侧向上注视受限。
与成人起病性睑下垂（由提上睑肌腱膜裂开所致）患者不同，因眼眶上部组织恶性浸润导致上睑下垂的成人患者在向下注视时可能出现上睑挂滞。这一重要体征应提醒临床医生注意潜在严重眼眶疾病的可能性。
