Isolated Neurogenic Blepharoptosis Secondary to Traumatic Eyelid Injury

Abstract

Abstract: : Purpose: Isolated neurogenic blepharoptosis due to peripheral oculomotor nerve disease is rare and when encountered usually due to compressive lesions. We describe a series of patients with isolated neurogenic ptosis secondary to traumatic eyelid injury. Methods: Observational case series. Results: Three previously healthy patients (2 males, 1 female; ages 29, 37, and 39) were evaluated for blepharoptosis following eyelid trauma. All three injuries involved forceful anterior displacement of the involved upper eyelid by a finger placed under the eyelid. Two occurred during domestic altercations and one while the patient was playing basketball. All patients were evaluated within 48 hours of injury and found to have complete ptosis with no levator function, consistent with loss of innervation to the levator palpebrae superioris muscle. Additional findings included minimal eyelid ecchymosis and edema in all cases and subconjunctival hemorrhage in two cases. All patients had full ocular motility and were orthophoric in all fields of gaze with no anisocoria. The remainder of the examinations of the involved and contralateral eyes was unremarkable with visual acuities correctable to 20/20. All cases were managed conservatively with observation only, and within two weeks all three patients had recovered completely with normal symmetric lid height and levator function. Conclusion: Ptosis secondary to isolated injury to the oculomotor nerve branch to levator palpebrae superioris may result from traumatic anterior displacement of the upper eyelid. Complete resolution is likely within two weeks.

Keywords: 608 trauma • 410 eyelid • 486 neuro-ophthalmology: diagnosis