Temporary Unilateral Neurogenic Blepharoptosis after Orbital Medial Wall Reconstruction: 3 Cases

Purpose: We report 3 cases of unilateral blepharoptosis after orbital medial wall reconstruction and describe the cause and clinical outcome. Methods: Observational case series. Results: Three previously healthy patients underwent reconstruction for orbital medial wall fracture. All 3 patients had complete unilateral upper eyelid ptosis with no levator palpebrae superioris muscle function immediately after their recovery from anesthesia. Additional findings included minimal eyelid ecchymosis, eyelid edema and subconjunctival hemorrhage, which all presented preoperatively. All 3 patients had full conjugated ocular motility in the entire field of gaze and no anisocoria. With oral steroid therapy, all 3 patients recovered completely with normal symmetric lid height and levator function within 1 month. Conclusion: Isolated neurogenic blepharoptosis after medial orbital wall reconstruction is a rare but favorable disease that may result from ischemic damage at the end portion of the superior branch of the oculomotor nerve in the orbit. High-dose steroid therapy early in the course of the disease was effective, and complete resolution was achieved within 1 month.