假性正负眼睑综合征1例

A case of pseudo plus-minus lid syndrome

患者,女,62岁,自觉右眼突出2年就诊,高血压3年。专科体格检查:右眼上睑退缩约1.5 mm,左眼上睑下垂约2.5 mm。提上睑肌肌力右眼13 mm,左眼9 mm。完善眼眶CT及头颅磁共振,未见异常。查阅文献,初步诊断为假性正负眼睑综合征。假性正负眼睑综合征符合赫林定律。通过左眼抬高试验发现右眼上睑退缩明显好转,安排左眼手术。术中发现左眼提上睑肌腱膜撕脱约7 mm,故行左眼提上睑肌前徙复位术,术后双眼上睑均回归正常位置且两边对称。假性正负眼睑综合征最常见的病因是重症肌无力,其他原因还包括甲状腺相关眼病、先天性上睑下垂、动眼神经麻痹、老年性上睑下垂及上睑成形术并发症等。临床工作中需抓住疾病的蛛丝马迹,真正做到诊疗如棋、破局而立,使患者得到精准的治疗。

A 62-year-old female patient presented with right eye protrusion for 2 years and hypertension for 3 years.Physical examination showed that the upper eyelid retraction of the right eye was about 1.5 mm,and the ptosis of left eye was about 2.5 mm.The levator upper eyelid muscle strength was 13 mm in the right eye and 9 mm in the left eye.Orbital CT and cranial MRI were completed,and no abnormalities were found.A preliminary diagnosis of pseudo plus-minus lid syndrome was made by literature review.Pseudo plus-minus lid syndrome conforms to the Herring’s law.The upper eyelid retraction of the right eye was significantly improved by the left eye elevation test.During the left eye surgery,it was found that the left levator aponeurotic was avulsed about 7 mm.so the left levator aponeurosis was repositioned.After the operation,the upper eyelids of both eyes returned to the normal position and both sides were symmetrical.The most common cause of pseudo Plus-Minus Lid Syndrome is myasthenia gravis.Other causes include thyroid-associated ophthalmopathy,congenital ptosis,oculomotor nerve palsy,senile ptosis,and complications of blepharoplasty.In clinical work,we need to grasp the clues of the disease,truly achieve the diagnosis and treatment like chess,break the game and stand,so that patients can get accurate treatment.