Purpose

Better understanding and management of a frontalis muscle hyperaction combined with upper eyelid retraction after bilateral ptosis surgery.

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Methods

Description of the case of a 59-year-old female patient, operated of ptosis in the right upper eyelid followed by the left upper eyelid 3 weeks after. She was post operatively, suffering of bilateral combined frontalis – levator overaction even after the surgery of the second eye.The early medical approach by using botulinium toxin in both frontalis and levator muscle has been done rather than wait and see the Hering law to operate or a possible surgical revision.

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Results

2 weeks after toxin treatment, the frontalis muscle was partially improved and the overactivity of the levator muscle has disappeared, replaced by complications that were difficult for the patient to cope with.Indeed, leakage of toxin, usually rare, was facilitated by the previous eyelid surgery resulting in many visual troubles, the esthetic deception of the initial surgical results increased by the people’s comments and the inability to resume work.Finally, by supporting the adverse events , and with the motor relearning of the toxin, the patient was satisfied of the aesthetic and functional result of her ptosis surgery.

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Conclusion

Usually, the ptosis post operative complication is pseudo eyelid retraction by overaction of the frontalis muscle or real surgical overcorected ptosis wich create upper eyelid retraction often accompanied by lagophtalmos and more or less severe symptoms of dry eyes.In this case, both were present, and the toxine approach reveals to be a good way, during the waiting time of a possible surgical revision of upper eyelid lengthening 6 months after the first surgery, or a good natural reposition of the muscles by neuroplasticity.The FLOS is not an intuitive complication and has to be early recognised to propose a solution. Moreover, Botulinium toxin is to consider in the management of the after effect of eyelid surgery as good in the esthetic than in the functional unusual cases like this one.

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Additional Authors

First name	Last name	Base Hospital / Institution
Naoufel	YOUSFI	Hopital Fondation Rothschild
Pierre-Vincent	JACOMET	Hopital Fondation Rothschild
Olivier	GALATOIRE	Hopital Fondation Rothschild

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