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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty-one patients presented for surgical correction of unilateral hypotropia of the globe and blepharoptosis. The hypotropia and pseudoptosis were corrected by Knapp procedures. The Bell's phenomenon was thereby improved, allowing safe correction of the true ptosis, generally by an anterior levator resection whose magnitude depended on measured levator function.
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PMID:Management of ipsilateral ptosis with hypotropia. 309 70

Ten infants and children who presented with craniofacial dysostosis are discussed; four had Apert's syndrome, four had Crouzon's syndrome, one had Pfeiffer's syndrome, and one had hypertelorism. The follow-up of the patients ranged from 3 months to 7 years, with an average of 19 months. Patients had bifrontal and biparietal craniectomies to correct frontal and temporal orbital retrusion, while two had left unilateral procedures only. One patient (T.S.) had had three similar procedures before he was 3 years old and patient B.B. had two before he was 11 months old due to the complete failure of bony orbital growth. Before the cranial surgery, one patient had a preexisting esotropia with bilateral congenital sixth nerve paresis, one had a V-pattern exotropia, and one had a right intermittent hypotropia due to right superior rectus weakness. In no case was there a change in the ocular alignment after infantile craniectomy. There were assorted ophthalmologic anomalies, such as congenital bilateral sixth nerve paresis, absent superior rectus function, bilateral ptosis in addition to absent superior rectus function, and two patients presented with frank and repeated exorbitism.
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PMID:Strabismus in craniofacial dysostosis. 340 45

The treatment for severe unilateral blepharoptosis is controversial. Sixteen consecutive cases of severe unilateral blepharoptosis were studied: eight had a super-maximum levator muscle resection (30 mm or more) and eight had a bilateral brow suspension with excision of the normal levator. Cosmetically acceptable results were achieved in six of eight cases undergoing a super maximum levator resection. Disparity in the palpebral fissure in downgaze ranged from 3 to 6 mm and was not bothersome to either patient or parent. Postoperative complications such as hypotropia and conjunctival prolapse can be minimized with careful technique. Four to eight cases undergoing bilateral brow suspension with excision of the normal levator had residual ptosis. Brow scars were occasionally noticeable. Overall cosmesis was considered better in the super-maximum levator resection group compared to the frontalis sling group by unbiased observers. Super-maximum levator resection is a good alternative in the treatment of severe unilateral blepharoptosis for selected cases, particularly for those who fear manipulation of the normal eyelid.
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PMID:Super-maximum levator resection for severe unilateral congenital blepharoptosis. 639 58

In seven patients with intracranial meningioma whose presenting signs and symptoms were ophthalmologic the underlying problem was initially misdiagnosed. Three patients had sphenoidal meningiomas with compression of the anterior visual pathways, but the initial diagnoses were acute optic neuritis, chronic optic neuritis and glaucoma. Two other patients had large frontal meningiomas causing in one case unilateral pain and swelling of the upper lid plus ptosis and hypotropia, and in the other case bilateral frontal morning headaches and intermittent blurring of vision in one eye; they were thought to have a frontal lobe osteoma and migraine respectively. A sixth patient had a large parietal meningioma causing unilateral papilledema in an eye with a corneal graft; the papilledema was not initially recognized because of severe astigmatism in that eye. The last patient had an occipital meningioma that had caused a fixed homonymous field defect and many years of "classic migraine".
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PMID:Meningioma and the ophthalmologist: diagnostic pitfalls. 719 8

The diagnosis and management of patients having had superior rectus suspension procedures for the correction of blepharoptosis can be quite difficult. Patients who have had these procedures frequently present with a syndrome which included 1) history of an unknown type of ptosis surgery performed at least ten years ago, 2) good eyelid excursion, 3) minimal lid lag associated with marked lagophthalmos, 4) hypotropia, and 5) corneal scarring. One must evert the upper eyelid to demonstrate the pathognomonic adhesion between tarsus and the superior rectus muscle. The correct management of this condition is virtually impossible until the diagnosis is made. To correct the corneal and motility problems that result from superior rectus suspension procedures, the adhesion between the superior rectus muscle and the upper eyelid must be released. It is very easy to overlook this syndrome if one is unaware of its presentation. We present five patients who illustrate the superior rectus suspension syndrome.
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PMID:The diagnosis and management of the superior rectus suspension syndrome. 726 56

The primary goal in mismanaged as well as untreated cases of combined double elevator muscle palsy and ptosis is alleviation of the paretic ocular motor imbalance to correct pseudoptosis, followed, if necessary, by levator resection to correct any residual true ptosis component. The great hypotropia often found in double elevator muscle palsy should be corrected, preferably by a muscle transposition procedure combined, in certain cases, with inferior rectus muscle recession if the inferior rectus muscle has contracted. Only in young patients can these two surgical procedures be safely combined, particularly if it is desirable to decrease the number of general anesthetics that the patient must take. Only after proper management of the paretic strabismus should the levator be resected, because, in certain cases, extraocular muscle surgery will completely abolish the upper lid ptosis.
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PMID:Surgically mismanaged ptosis associated with double elevator palsy. 745 35

A nuclear oculomotor nerve syndrome is rarely caused by mesencephalic lesions. We describe 5 patients, 4 with unilateral syndrome (3 due to ischemia and 1 to mesencephalic hemorrhage) and 1 with bilateral nuclear ischemia of the third cranial nerve. These patients represent 0.2% of those admitted with cerebral vascular pathology over the last 12 years. Symptoms are consistent with descriptions of the anatomic organization of this nucleus, with peripheral paralysis of the contralateral superior rectus and possible bilateral involvement of the eyelid elevator and the pupillary constrictor muscles. A noteworthy symptom seen in these cases is supranuclear paralysis of the upward gaze on the side of the lesion, with ocular elevation achieved in response to oculocephalic stimuli in 2 cases and with Bell's synkinesis in 4. We analyze the nature of 22 published cases of unilateral nuclear damage and of 14 published cases of bilateral nuclear damage. Unilateral damage may or may not lead to ipsilateral pupillary involvement, uni- or bilateral eyelid ptosis, contralateral ocular hypotropia, and possible horizontal paresis of the contralateral gaze. Associated deficits are hemiparesis or crossed hemiataxia. Unresponsive pupils and bilateral ptosis associated with tetraparesis, bilateral ataxia and altered states of consciousness were seen with bilateral nuclear lesions. Infarction is the main cause (in 32 out of 41) and recovery of full ocular movement is uncommon.
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PMID:[Nuclear oculomotor nerve syndrome due to mesencephalic infarction or hemorrhage. Five cases and a review of literature]. 808 84

We have analyzed the etiological causes of ptosis in a retrospective study of 484 cases undergoing operation. This study has confirmed how difficult it is to classify ptosis despite the different existing classifications. Some authors divide ptosis into two groups: congenital and acquired. These classifications seem to have been abandoned now for classifications based on the mechanism that instigates ptosis rather than the moment when the deficit developed. We chose to classify ptosis into five subgroups: myogenic (42% of the cases studied), aponeurotic (35.3%), neurogenic (6.8%), mixed (15.9%), and pseudoptosis (enophthalmos, eyelid tumor, hypotropia, etc.), the latter of which were removed from this series. This classification is based on clinical and surgical criteria. It has the advantages of unity, simplicity, and practicality in terms of establishing a treatment plan for a given ptosis patient. Indeed, each subgroup requires a particular clinical examination and a more stereotyped surgical treatment.
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PMID:[Etiologic causes of ptosis about a serie of 484 cases. To a new classification?]. 1252 24

Fibrosis of the extraocular muscles can be an acquired or congenital disorder (CFEOM). The congenital disorder(1) is a complex strabismus with congenital restrictive ophthalmoplegia with or without ptosis. The surgery is challenging because the eye muscles are replaced by fibrous tissue or fibrous bands and in most cases the results are not satisfactory. We present the first case report of unilateral CFEOM with palpebral adherence and hypotropia, which was managed with our technique of a silicon plate implant on the orbital floor. The purpose of the implantation of the silicon plate in the orbital floor is to improve the hypotropia caused by CFEOM.
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PMID:Unilateral congenital fibrosis of the extraocular muscles with lid retraction: surgical treatment with a silicon plate on the orbital floor. 2131 37

We describe two brothers with Joubert syndrome (JS). JS diagnosis was made on the basis of neurological findings and the presence of the characteristic "molar tooth sign", which was subsequently confirmed by magnetic resonance imaging. Both brothers demonstrated ptosis, hypotropia, exotropia, and horizontal pendular nystagmus. The younger brother had mild chorioretinal discoloration at the peripapillary region in both eyes, and a small coloboma at the inferior region of his right optic disc. The elder brother had coloboma in his right eye and a colobomatous optic disc in his left eye. Optical coherence tomography showed that the foveal architecture was preserved in both patients. We discuss the ocular findings, including those from optical coherence tomography, in JS, which has recently been recognized as ciliopathy.
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PMID:Ocular findings in two siblings with Joubert syndrome. 2453 Nov 65


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