Challenging Ptosis Scenarios

  • John B. Holds
  • Adam G. Buchanan
  • Morris Hartstein
  • David A. Weinberg
  • Adam J. Cohen


Ptosis is a common feature of both benign essential blepharospasm and hemifacial spasm. Mechanisms include excessive protractor muscle tone, levator aponeurosis dehiscence, apraxia, or response to botulinum toxin therapy. Treatment modalities include botulinum toxin injections, surgical ptosis repair, and myectomy.


Botulinum Toxin Hemifacial Spasm Plexiform Neurofibroma Eyelid Margin Eyelid Opening 


  1. 1.
    Fang LJ, Vidaud D, Vidaud M, Thirion JP. Identification and characterization of four novel large deletions in the human neurofibromatosis type 1 (NF 1) gene. Hum Mutat. 2001;18(6):549–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Jackson IT, Carbonnel A, Potparic Z, Shaw K. Orbitotemporal neurofibromatosis: classification and treatment. Plast Reconstr Surg. 1993;92(1):1–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Fukuta K, Jackson IT. Orbital neurofibromatosis with enophthalmos. Br J Plast Surg. 1993;46:36–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Jackson IT, Laws ER, Martin R. The surgical management of orbital neurofibromatosis. Plast Reconstr Surg. 1983;71(6):751–8.CrossRefPubMedGoogle Scholar

Suggested Reading

  1. 5.
    Holds JB, White GL, Thiese SM, Anderson RL. Facial dystonia, essential blepharospasm and hemifacial spasm. Am Fam Physician. 1991;43(6):2113–20.PubMedGoogle Scholar
  2. 6.
    Anderson RL, Patel BCK, Holds JB, Jordan DR. Blepharospasm: past, present and future. Ophthal Plast Reconstr Surg. 1998;14:305–17.CrossRefPubMedGoogle Scholar
  3. 7.
    Esteban A, Traba A, Prieto J. Eyelid movements in health and disease. The supranuclear impairment of the palpebral motility. Neurophysiol Clin. 2004;34(1):3–15.CrossRefPubMedGoogle Scholar
  4. 8.
    Patrinely JR, Whiting AS, Anderson RL. Local side effects of botulinum toxin injections. Adv Neurol. 1988;49:493–500.PubMedGoogle Scholar
  5. 9.
    Lucci LM, Yen MT, Anderson RL, Hwang IP, Black RE. Orbicularis myectomy with levator advancement in Schwartz-Jampel syndrome. Am J Ophthalmol. 2001;132(5):799–801.CrossRefPubMedGoogle Scholar
  6. 10.
    Anderson RL, Beard C. The levator aponeurosis. Attachments and their clinical significance. Arch Ophthalmol. 1977;95:1437–41.PubMedGoogle Scholar
  7. 11.
    Gillum WN, Anderson RL. Blepharospasm surgery. An anatomical approach. Arch Ophthalmol. 1981;99(6):1056–62.PubMedGoogle Scholar
  8. 12.
    Anderson RL, Patrinely JR. Surgical management of blepharospasm. Adv Neurol. 1988;49:501–20.PubMedGoogle Scholar
  9. 13.
    Garland PE, Patrinely JR, Anderson RL. Hemifacial spasm. Results of unilateral myectomy. Ophthalmology. 1987;94(3):288–94.PubMedGoogle Scholar
  10. 14.
    Holds JB. Ptosis (Ch. 79). In: Albert DM, editor-in-chief. Ophthalmic surgery: Principles and techniques. malden, MA: Blackwell Science; 1999. pp. 1307–26.Google Scholar
  11. 15.
    Holds JB, Anderson RL. Blepharoptosis (Ch. 12). In: Tse DT, editor. Color atlas of ophthalmic surgery, Vol. 6– Oculoplastic Surgery. Philadelphia, PA: J.B. Lippincott Co.; 1992. pp. 151–74.Google Scholar
  12. 16.
    Baroody M, Holds JB, Vick VL. Advances in the diagnosis and treatment of ptosis. Curr Opin Ophthalmol. 2005;16(6):351–5.CrossRefPubMedGoogle Scholar
  13. 17.
    Wabbels B, Roggenkämper P. Long-term follow-up of patients with frontalis sling operation in the treatment of essential blepharospasm unresponsive to botulinum toxin therapy. Graefes Arch Clin Exp Ophthalmol. 2007;245(1):45–50.CrossRefPubMedGoogle Scholar
  14. 18.
    Leone CR, Shore JW, Van Gemert JV. Silicone rod frontalis sling for the correction of blepharoptosis. Ophthalmic Surg. 1981;12:881–7.PubMedGoogle Scholar
  15. 19.
    Demartelaere SL, Blaydon SM, Shore JW. Tarsal switch levator resection for the treatment of blepharoptosis in patients with poor eye protective mechanisms. Ophthalmology. 2006;113:2357–63.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • John B. Holds
    • 1
  • Adam G. Buchanan
  • Morris Hartstein
  • David A. Weinberg
  • Adam J. Cohen
  1. 1.Departments of Ophthalmology and Otolaryngology/Head and Neck SurgerySaint Louis University, Ophthalmic Plastic and Cosmetic Surgery, Inc.St. Louis, Des PeresUSA

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