Retrospective study on management of traumatic ptosis-Experience in tertiary eye centre
Author: Sindhuja Murugesan
Base Hospital / Institution: Trinity Eye Hospital, Coimbatore
ePoster presentation
Abstract ID: 24-182
Purpose
Traumatic ptosis occurs either due to direct injury to levator muscle, dehiscence of its aponeurosis or injury to nerve supply. Due to heterogeneous nature of traumatic ptosis its prognosis & management is difficult. The purpose of this study is to present our experience in its management.
Methods
Retrospective study where medical records of 14 patients were taken with traumatic ptosis to study nature of injury, mechanism of ptosis, prognosis &management from Jan 2022-Jan 2024. Informed consent was taken. Patients with previous eyelid surgery, pre-existing ptosis, lost to follow-up,give consent were excluded. Ptosis evaluation marginal reflex distance 1 (MRD 1), levator muscle(LPS)action, bell’s, EOM at baseline & over course of management were noted. If surgery was performed,success rate & surgical complications were noted. If LPS action was more than 5mm LPS resection/plication was performed & action <5mm frontalis sling with silicone rod.
Results
9 males & 5 females.Mode of injury RTA in 8 patients, 4 had hook injury.It was divided into five subcategories based on mechanism of injury & findings:
1.Myogenic: Direct injury to the LPS/Müller’s muscle,seen in 6 patients(43%).
2.Aponeurotic: Dehiscence of LPS aponeurosis from its tarsus without injury to muscle,4 patients this was seen associated with hook injury.
3.Mechanical: Cicatricial bands tethering/weighing down lid, 2 patients(14%) with this subtype.
4.Neurogenic: Neural injury to oculomotor nerve or sympathetic fibers. 2 patients(14%) in this category.
MRD1 ranged from -3 to +2mm and levator action 2-12mm. 6 patients had spontaneous resolution of ptosis over a period of 8-12 weeks, levator resection was done in 5 patients & frontalis sling was done in 3. Good correction was obtained in 12 patients & 2 had recurrence within 1 year.
Conclusion
Traumatic ptosis is heterogenous. Systematically evaluating by the mechanism can guide decision about prognosis and management. We suggest that there are meaningful differences between traumatic ptosis subtypes which can be used to guide a more systematic approach to tailoring patient care and prognosis.
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