活检证实提上睑肌结节病病变引起肌源性上睑下垂

Q3 Medicine

American Journal of Ophthalmology Case Reports Pub Date : 2025-07-12 DOI:10.1016/j.ajoc.2025.102390

Kim A. Firn, Eman Hawy, Douglas J. Van Putten

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引用次数: 0

摘要

目的报告一例肌源性上睑下垂，结节病直接累及上睑提肌，活检证实。观察一例43岁男性高血压高脂血症患者，表现为进行性右上睑下垂4个月，干咳2个月。检查发现血清酶升高，肺门腺病变，双侧泪腺和右提肌MRI增强。泪腺活检和后来的提肛活检均符合结节病。结论及重要性结节病相关性上睑下垂多继发于霍纳综合征或泪腺肿大引起的肿块效应。在文献回顾中，我们没有发现先前活检证实的直接累及提上睑肌是结节病相关性上睑下垂的原因。没有病例被确定为孤立的提上睑肌增强而不累及其他眼外肌。本例中，泪腺和提肛活检均符合结节病。以前报道的结节病相关的上睑下垂继发于泪腺肿大，活检呈阳性，实际上可能是由于提上睑肌的直接共同累及。如果药物治疗失败，结节病相关上睑下垂的确切机制会影响拟议的手术干预，在手术计划之前应考虑直接累及提上睑肌。

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Biopsy-proven sarcoidosis lesion of the levator palpebrae superioris causing myogenic blepharoptosis

Purpose

We describe a case of myogenic blepharoptosis due to sarcoidosis directly involving the levator palpebrae superioris, confirmed with biopsy.

Observations

A 43-year-old male with hypertension and hyperlipidemia presented with four months of progressive right blepharoptosis and two months of dry cough. Workup revealed elevated serum muramidase, hilar adenopathy, and bilateral lacrimal gland and right levator MRI enhancement. Both lacrimal gland biopsy and later levator biopsy were consistent with sarcoidosis.

Conclusions and importance

Most sarcoidosis-related blepharoptosis is secondary to Horner syndrome or mass effect from lacrimal gland enlargement. On literature review, we did not identify prior biopsy-confirmed direct involvement of the levator as a cause of sarcoidosis-related blepharoptosis. No cases were identified with isolated levator enhancement without involvement of other extraocular muscles. In this case, both the lacrimal gland and levator biopsies were consistent with sarcoidosis. It is possible that prior reports of sarcoidosis-related blepharoptosis secondary to lacrimal gland enlargement with positive biopsy were in fact due to direct co-involvement of the levator. The exact mechanism of sarcoidosis-related blepharoptosis impacts the proposed surgical intervention if indicated after failed medical therapy, and direct levator involvement should be considered prior to surgical planning.

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来源期刊

American Journal of Ophthalmology Case Reports Medicine-Ophthalmology

CiteScore

2.40

自引率

0.00%

发文量

513

审稿时长

16 weeks

期刊介绍： The American Journal of Ophthalmology Case Reports is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished case report manuscripts directed to ophthalmologists and visual science specialists. The cases shall be challenging and stimulating but shall also be presented in an educational format to engage the readers as if they are working alongside with the caring clinician scientists to manage the patients. Submissions shall be clear, concise, and well-documented reports. Brief reports and case series submissions on specific themes are also very welcome.