Song Hyunsuk, Lim Seong Yoon, Park Myong Chul, Lee Il Jae, Park Dong Ha
From the Department of Plastic and Reconstructive Surgery, Ajou University Hospital, Suwon, Korea.
J Craniofac Surg. 2014 May;25(3):1106-8. doi: 10.1097/SCS.0000000000000719.
Neurogenic blepharoptosis related to orbital surgery is very rare and only 1 report was published in the literature. This report presents 1 case of transient and isolated neurogenic blepharoptosis after medial orbital wall reconstruction. A 12-year-old male patient who suffered from periorbital trauma visited our hospital with right periorbital pain. During the physical examination, mild ecchymosis and eyelid edema were reported; however, there were no signs of either limitation of ocular motion or anisocoria. On the orbital CT images, a 17 mm × 20 mm-sized medial orbital bony defect was observed and the medial rectus muscle and orbital fat were herniated. The operation was performed 12 days after injury and the transcaruncular approach was used to reach the medial orbital wall. After the operation, he had right side blepharoptosis with mild eyelid edema and ecchymosis. However, ocular movement was normal and there were no signs of anisocoria. He did not receive any additional medication for blepharoptosis and was discharged 3 days postoperation. By the ninth day of postoperative recovery, the patient still suffered from right blepharoptosis with no levator palpebrae superioris muscle function. We prescribed a low dose of oral corticosteroid and the patient was monitored on a weekly basis. Finally, he recovered completely with normal symmetric eyelid position and levator function.
与眼眶手术相关的神经源性上睑下垂非常罕见，文献中仅发表过1例报道。本报告介绍1例眼眶内侧壁重建术后出现的短暂性孤立性神经源性上睑下垂病例。一名12岁男性患者因眶周外伤前来我院就诊，伴有右侧眶周疼痛。体格检查发现轻度瘀斑和眼睑水肿；然而，未发现眼球运动受限或瞳孔不等大的体征。眼眶CT图像显示眼眶内侧有一个17mm×20mm大小的骨缺损，内侧直肌和眶脂肪疝出。受伤12天后进行手术，采用经泪阜入路到达眼眶内侧壁。术后，他出现右侧上睑下垂，伴有轻度眼睑水肿和瘀斑。然而，眼球运动正常，未发现瞳孔不等大的体征。他未接受任何针对上睑下垂的额外药物治疗，术后3天出院。术后恢复到第9天时，患者仍存在右侧上睑下垂，提上睑肌无功能。我们给予低剂量口服皮质类固醇，并每周对患者进行监测。最终，他完全康复，眼睑位置对称且提上睑肌功能正常。
