Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
Department of Strabismus and Pediatric Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
BMC Ophthalmol. 2024 May 31;24(1):232. doi: 10.1186/s12886-024-03485-8.
Blepharoptosis is a common symptom in ophthalmology clinic, but eyelid retraction when smiling in a ptosis eye is a rare manifestation. Here we report a novel manifestation that eyelid retraction during smiling in a patient with monocular congenital ptosis.
A 10-year-old girl with isolated and mild unilateral congenital ptosis showed eyelid retraction in ptotsis eye when smiling together with a lid lag on downgaze. She didn't have any systematic and ocular diseases other than myopia and astigmatism.Eyelid retraction during smiling is 5 mm, resulting in a significant difference in the height of bilateral palpebral fissures.As for ptosis, is mild.The margin to reflex distance 1 is 1.0 mm on the right eye(ptosis eye) and 3.0 mm on the left eye. A lid lag of 1.0 mm on downward gaze was noted on the right, she could close her eyes fully while sleeping.The ice pack test, laboratory test for thyroid function, whole-exome sequencing (WES) and magnetic resonance imaging(MRI) of the orbital and ocular motor nerves showed normal results.Her symptoms alleviated after 6 months, with the retraction of the right upper eyelid when smiling was approximately 3 mm, thus the difference in the palpebral fissure height when smiling was smaller than that at the initial presentation.
Blepharoptosis may accompanied with abnormal innervation like eyelid retraction, this phenomenon can be alleviated with age.The results of the levator muscle function test should be carefully examined to determine whether it is ptosis in an impaired innervation eyelid.
上睑下垂是眼科门诊的常见症状，但在下垂的眼睑微笑时出现眼睑退缩是一种罕见的表现。我们在此报告一例单侧先天性上睑下垂患者微笑时出现眼睑退缩的新表现。
一名 10 岁女孩患有孤立性和轻度单侧先天性上睑下垂，表现为在微笑时上睑下垂的眼睛出现眼睑退缩，同时在向下注视时出现眼睑迟滞。除近视和散光外，她没有任何系统性和眼部疾病。微笑时的眼睑退缩为 5mm，导致双侧睑裂高度差异明显。对于上睑下垂，程度较轻。右眼（下垂眼）的Marginal to reflex distance 1 为 1.0mm，左眼为 3.0mm。右侧向下注视时出现 1.0mm 的眼睑迟滞，她可以在睡眠时完全闭眼。冰袋试验、甲状腺功能实验室检查、全外显子组测序（WES）和眼眶及眼运动神经磁共振成像（MRI）均显示正常结果。她的症状在 6 个月后缓解，右侧上眼睑在微笑时的退缩约为 3mm，因此微笑时睑裂高度的差异小于初次就诊时。
上睑下垂可能伴有异常神经支配，如眼睑退缩，这种现象随着年龄的增长会缓解。应仔细检查提上睑肌功能测试的结果，以确定是否存在神经支配受损的眼睑下垂。
