John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri, U.S.A.
Ophthalmic Plast Reconstr Surg. 2022;38(5):448-451. doi: 10.1097/IOP.0000000000002157. Epub 2022 Mar 23.
Psychogenic ptosis is a rare ophthalmic manifestation of conversion disorder. The aim of this study was to describe the clinical parameters, etiology, psychological, and clinical aspects of psychogenic ptosis.
A retrospective case series was conducted of patients with psychogenic ptosis seen between 1990 to 2020. Medical records were reviewed for patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and resolution rates. A literature review was performed to identify cases of psychogenic ptosis previously published between 1990 and 2020.
Six female patients (aged 14-60 years) were diagnosed with unilateral psychogenic ptosis. Physical trauma preceded the onset of ptosis in all cases. Imaging studies had been previously obtained in all patients, none of who were correctly diagnosed at time of referral. Associated signs included concurrent brow ptosis, orbicularis oculi spasm, squint on upgaze, and variable levator function and eyelid margin measurements. Four patients had preexisting psychological conditions. Patients were primarily managed with reassurance.
Psychogenic ptosis is an often delayed or misdiagnosed condition, resulting in unnecessary referrals and imaging. Psychogenic ptosis should be considered in patients with atypical findings of ptosis including ipsilateral brow depression, orbicularis oculi spasm, squint on upgaze, and variable eyelid measurements. A prior history of minor trauma and female sex were common in this series. Our experience suggests that psychogenic ptosis can often be treated with reassurance, leading to partial or complete resolution. Given the number of patients with comorbid psychiatric conditions, the authors recommend a low threshold for psychiatric or psychological evaluation.
心因性上睑下垂是转换障碍的一种罕见眼部表现。本研究旨在描述心因性上睑下垂的临床参数、病因、心理和临床方面。
对 1990 年至 2020 年间就诊的心因性上睑下垂患者进行回顾性病例系列研究。回顾患者的人口统计学资料，包括精神病史、临床发现、诊断研究、治疗和缓解率。进行文献回顾，以确定 1990 年至 2020 年间发表的先前有关心因性上睑下垂的病例。
6 名女性患者（年龄 14-60 岁）被诊断为单侧心因性上睑下垂。所有病例在上睑下垂发作前均有躯体创伤史。所有患者均已进行影像学检查，但在转诊时均未得到正确诊断。相关体征包括同时出现的眉下垂、眼轮匝肌痉挛、上视斜视和提上睑肌功能及睑缘测量值不同。4 名患者有先前存在的心理疾病。患者主要通过安抚治疗进行管理。
心因性上睑下垂是一种常被延迟或误诊的疾病，导致不必要的转诊和影像学检查。对于上睑下垂的不典型表现，包括同侧眉下垂、眼轮匝肌痉挛、上视斜视和不同的睑缘测量值，应考虑心因性上睑下垂。本系列中常见的特征包括先前有轻微创伤史和女性。我们的经验表明，心因性上睑下垂通常可以通过安抚治疗来治疗，导致部分或完全缓解。鉴于许多患者存在合并的精神疾病，作者建议对精神科或心理评估的门槛较低。
