Spontaneous improvement of levator palpebrae superioris function after traumatic transection

Abstract

Direct traumatic injury to the levator palpebrae superioris aponeurosis typically results in upper eyelid ptosis. The mechanisms can involve mechanical or neurogenic etiologies. Prompt surgical exploration and repair are required for restoration of normal function. In cases where prompt surgical intervention is not performed or the levator palpebrae superioris aponeurosis cannot be repaired, the restorative options are limited. The options are further restricted by concurrent ipsilateral frontalis paresis. This report details a spontaneous return of levator function nine months after complete traumatic transection of the levator palpebrae superioris aponeurosis complicated by concurrent ipsilateral frontalis paresis.

Keywords: Levator palpebrae superioris aponeurosis; Neurogenic ptosis; Oculoplastic surgery; Traumatic transection.

Fig. 1

Patient at time of initial presentation. There was near complete avulsion of the right upper eye lid resulting in transection of the LPSA.

Fig. 2

Patient at one month follow up exam following direct repair of right upper eyelid avulsion without exploration for or repair of the LPSA, resulting in complete mechanical ptosis and no levator function.

Fig. 3

Intraoperative image showing lid position and contour of right and left upper eyelids.