Photographer: Audrey C. Ko, MD
Posted June 19, 2018
A 69-year-old man with history of facial malignancy presented with mechanical and cicatricial left lower eyelid retraction and ectropion after surgical resection and radiation (Figure 1). Examination revealed exposure keratopathy and a non-healing corneal epithelial defect. There can be delayed wound healing and chronic fibrosis in patients who have had radiation . Thus, this patient was not a good candidate for surgical or temporary suture tarsorrhaphy.
A neurotoxin tarsorrhaphy was performed since it is a safe and effective method to protect the cornea . Moreover, this procedure can be done in the clinic setting and allows further examination of the eye, as it does not permanently fuse the eyelids. Following neurotoxin injection in the left upper eyelid, complete ptosis was successfully achieved (Figure 2), and the patient reported overall improvement in his symptoms. The corneal epithelial defect subsequently resolved.
- Jacobson LK, Johnson MB, Dedhia RD, Niknam-Bienia S, Wong AK. Impaired wound healing after radiation therapy: A systematic review of pathogenesis and treatment. JPRAS Open. 2017;13:92-105. doi:10.1016/j.jpra.2017.04.001.
- Khairy H. Botulinum toxin A-induced ptosis: A safe and effective alternative to surgical tarsorrhaphy for corneal protection. Journal of the Egyptian Ophthalmological Society. 2014;107(1):20-22. doi:10.4103/2090-0686.134937.
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