Steroid-induced ptosis: case studies and histopathologic analysis

Eye (2008) 22, 491495 & 2008 Nature Publishing Group All rights reserved 0950-222X/08 $30.00

www.nature.com/eye

A Song, KD Carter, JA Nerad, C Boldt and J Folk

Steroid-induced ptosis: case studies and histopathologic analysis

CLINICAL

STUDY

Abstract

Purpose The purpose of this study was to review patients who developed ptosis after subtenons steroid injection and to study the mechanism of steroid-induced ptosis in an animal model.

Methods Part 1. Twenty-two patients with uveitis who had received posterior subtenons triamcinolone acetonide injections were retrospectively reviewed. Demographics, type of uveitis, type and number of surgeries, pre and postoperative marginal reex distance (MRD1), and clinical outcomes were evaluated. Part 2. Study of rabbit levator muscle and aponeurosis histopathology after subtenons triamcinolone injection was performed.

Results Part 1. The average age was 44.6 years (range: 14 85 years) with a mean follow-up of 14 months. The most common causes of uveitis included uveitis after cataract extraction (ve), pars planitis (three), multifocal choroiditis (three), and juvenile rheumatoid arthritis (three). The average time to documented onset of ptosis was 13.9 months (range: 049 months). In patients who received only one steroid injection, the average time to ptosis recorded was 2.7 months (range: 06 months). Seventeen patients underwent ptosis repair. Part 2. No ptosis was noted in the experimental and control groups. Histopathologic analysis of levator tissues revealed no signicant difference in atrophy or degree of inammation between experimental and control groups. Conclusions Ptosis following subtenons steroid injection ranged from mild to moderate and occurred a few months after steroid injection. Prior studies of muscles and periocular tissues exposed to corticosteroids demonstrated degenerative muscle changes; our studies revealed no histopathologic changes in the levator muscle or aponeurosis.

Eye (2008) 22, 491495; doi:10.1038/sj.eye.6702667; published online 12 Janaury 2007

Keywords: ptasis; Subtenonis steroid injection; histopathology

Introduction

Corticosteroids are potent medications commonly used to decrease ocular inammation. However, a variety of adverse ocular and systemic side effects can occur with the use of periocular steroids, including decreased wound strength, orbital fat atrophy, decreased ocular motility.14

A common indication for periocular steroid injections is the treatment of uveitis. Posterior subtenons injections of triamcinolone acetonide (TAA) allow a high concentration of long-acting steroids to be placed close to the posterior aspect of the globe; this is useful in...