Lai Chun-Chieh, Lin Chia-Chen
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Front Med (Lausanne). 2022 Apr 13;9:877162. doi: 10.3389/fmed.2022.877162. eCollection 2022.
Lagophthalmos with exposure keratopathy is a potential vision-threatening complication following surgery for blepharoptosis. We report three cases successfully treated with botulinum toxin-A (Botox, Allergan, Irvine, USA) for this complication.
Three patients presented with severe blepharoptosis after surgery for orbital and frontal base tumors. They obtained good appearances after frontalis-orbicularis oculi muscle (FOOM) flap shortening. However, exposure keratopathy developed after the surgery despite frequent use of topical lubricants and autologous serum eye drops. We injected 5-10 units of botulinum toxin-A around the central supra-brow area, which was near the origin of the FOOM flap. One week later, they developed ptosis and could close the eye completely. The corneal defect gradually resolved. They recovered from ptosis 3 months later and never required a second injection.
Lagophthalmos with exposure keratopathy is a potential vision-threatening complication following FOOM flap surgery. In severe cases, surgical revision should be considered to partially or totally release the FOOM flap attachment, which also decreases its function permanently. In this case series, we demonstrated that injecting botulinum toxin-A may be a promising method to manage this complication without permanently affecting the function of the FOOM flap.
A botulinum toxin-A injection may be an effective treatment for patients developing exposure keratopathy after FOOM flap surgery.
睑裂闭合不全伴暴露性角膜病变是睑下垂手术后一种潜在的视力威胁性并发症。我们报告3例采用A型肉毒毒素（保妥适，美国艾尔建公司，尔湾市）成功治疗该并发症的病例。
3例患者因眼眶及额底部肿瘤手术后出现严重睑下垂。行额肌-眼轮匝肌（FOOM）瓣缩短术后外观改善良好。然而，尽管频繁使用局部润滑剂和自体血清滴眼液，术后仍发生了暴露性角膜病变。我们在靠近FOOM瓣起始处的眉中央上方区域周围注射5-10单位A型肉毒毒素。1周后，患者出现上睑下垂，能够完全闭合眼睛。角膜缺损逐渐愈合。3个月后上睑下垂恢复，且无需再次注射。
睑裂闭合不全伴暴露性角膜病变是FOOM瓣手术后一种潜在的视力威胁性并发症。在严重病例中，应考虑手术矫正以部分或完全松解FOOM瓣附着，这也会永久性降低其功能。在本病例系列中，我们证明注射A型肉毒毒素可能是处理该并发症的一种有前景的方法，且不会永久性影响FOOM瓣的功能。
注射A型肉毒毒素可能是治疗FOOM瓣手术后发生暴露性角膜病变患者的一种有效方法。
