Purpose

To delineate a potential association between bilateral periocular syringomas and acquired aponeurotic ptosis, and to emphasize a possibly underrecognized clinical phenomenon.

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Methods

We performed a case series involving four male patients, aged 31 to 42 years, with bilateral periocular syringomas. Thorough ophthalmologic, cranial nerves, and eyelid tests were carried out, which included levator function, palpebral fissure height, marginal reflex distance-1 (MRD-1), and, if relevant, reaction to phenylephrine testing. Prior ocular surgery, steroid exposure, contact lens use, trauma, and other known risk factors for acquired ptosis were methodically excluded.

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Results

All patients demonstrated mild to moderate ptosis (MRD-1 ≤2 mm in at least one eye) with preserved to excellent levator function. Syringomas involved the upper and/or lower eyelids bilaterally. Common associated findings included downward slanting of the lateral canthus and inferior scleral show. Phenylephrine test response was variable. None of the patients had identifiable systemic, neurologic, or mechanical risk factors for ptosis. Surgical management including Müller’s muscle conjunctival resection, external levator advancement and posterior levatorpexy resulted in satisfactory postoperative eyelid position.

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Conclusion

This case series identifies a potentially overlooked clinical phenomenon; mechanical effects, infiltrative alterations, and long-term inflammatory processes affecting eyelid tissues are some of the proposed explanations . Understanding this relationship could enhance diagnostic evaluation and treatment approaches for people with periocular syringomas and malpositioned eyelids.

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Additional Authors

First name	Last name	Base Hospital / Institution
Naif	Alsulaiman	King Khaled Eye Specialist Hospital and Research Center
Nada	Almadhi	King Khaled Eye Specialist Hospital and Research Center

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