Abstract Listings 2025

Purpose

To discuss the diagnostic challenges and management in patients presenting with unilateral ptosis.

Methods

Retrospective review of case note.

Results

A 65 year old lady presented with a 3 week history of right upper eyelid swelling and droopy eyelid. No visual symptoms, no diplopia no known systemic conditions.On examination a lesion was palpable in the right upper eyelid with the remainder of the examination being normal.An urgent MRI scan with contrast showed enlargement of the lacrimal gland and diffuse involvement of the orbital tissues. Biopsy of the lesion showed non caesating granulomatous features with clusters of epithelioid and multinucleated gaint cells. The patient under went blood investigations, chest x-Ray and systemic review. She was started on steroids for sarcoidosis.There was no significant change in her right upper eyelid ptosis with systemic treatment. She had a 2mm ptosis of the right upper eyelid with levator function of 6mm. The patient under successful frontalis advancement flap surgery to correct the ptosis

Conclusion

Ocular involvement in patients with system sarcoidosis has been reported to range between 12% -76%. The most common feature is uveitis with unilateral ptosis being an unusual presentation as a first manifestation of sarcoidosis. Ptosis surgery in patients with sarcoidosis is a challenge due to chronic inflammation of eyelid tissue. In this case we wanted to avoid using any synthetic material for ptosis surgery due to the risks of granuloma formation. A frontalis muscle advancement flap was fashioned and attached to the tarsal plate. This case highlights the diagnostic and management challenges in patients presenting with unilateral ptosis.

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