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III and VII nerve palsy and brow suspension for ptosis repair: follow-up and unexpected clinical manifestations

Poster Details

First Author: I.Zampros GREECE

Co Author(s):    E. Kanonidou   K. Boboridis   G. Sakkias        

Abstract Details



Purpose:

To show that the surgical management of blepharoptosis related to III nerve palsy may lead to ocular complications that may threat the visual function of the patient.

Setting:

Department of Ophthalmology, ''Hippokrateion'' General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

A 17 year old male patient presented to the emergency department of our hospital with diffuse conjunctival edema especially in the inferotemporal and inferonasal quadrants of the right eye (RE). Examination revealed: light perception on the right with inferior corneal ulceration with concurrent hypopyon and fixed mid-dilated pupil. There was no view of fundus with equal red reflex. There was no ocular mobility of the right eye. The patient underwent surgery twice for excision of pituitary gland tumor (germinoma), first intranasal and then intracranial surgery. Postoperatively, a III and VII nerve palsy was detected with total ptosis for which the patient underwent brow suspension which resulted in fixed elevated eyelid.Full blood and biochemichal tests, corneal culture , CT and MRI scans were performed as well .

Results:

Intense treatment with topical antibiotics and lubricants and IV antibiotics was initiated . A right central pilar tarsorrhaphy was performed for a temporar corneal protection as the patient rejected the division of ptosis slings.

Conclusions:

III and VII nerve palsy can lead to severe ocular complications. Brow suspension for blepharoptosis related to III and VII nerve palsy is contraindicated and can lead to severe corneal exposure. The ophthalmologist should always be aware of the indications and complications and chose the appropriate intervention in order to avoid complications and maximize success. FINANCIAL INTEREST: NONE

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