(Disclaimer: This article is for general use only, and the following information has been processed to protect the privacy of the child)
Abstract: The child is a 7-year-old boy who has not been able to open his right eye very much since birth, and his parents did not pay attention to it. She was admitted to the hospital for correction of congenital ptosis of the right eye (frontal flap suspension) combined with blepharoplasty, and the postoperative result was good.
Basic information】Male, 7 years old
Disease Type】Congenital ptosis of the right eye
Hospital】Guangdong Maternal and Child Health Hospital
Date of Consultation】September 2020
Treatment plan】Congenital ptosis of the right eye (frontal flap suspension) combined with blepharoplasty and topical levofloxacin hydrochloride ophthalmic gel
Treatment Period】4 days of hospitalization, 10 days of outpatient stitch removal after surgery
Treatment effect】The postoperative result is good, the right eye is symmetrical and equal to the left eyelid fissure, and can be lifted
I. Initial consultation
The parents complained that the child’s right eye had not opened much since birth, and upon questioning, there was no morning lightness or evening heaviness. The child was sometimes teased by his classmates and had poor vision in his right eye, so he only used his left eye to see things in daily life, which affected his study to a certain extent. The patient’s lid fissure height was found to be 4 mm in the right eye and 10 mm in the left eye when she looked at the right eye, 1 mm in the right eye and 10 mm in the left eye when she looked at the upper eyelid muscles, 9 mm in the right eye and 9 mm in the left eye when she looked at the frontal muscles, Bell’s syndrome (+), and a negative neostigmine test (10 min, 20 min, 30 min, 40 min, 50 min, 60 min). The height remained the same, 4mm in the right eye and 10mm in the left eye), and no significant abnormality was found in the cranial CT examination, and no significant abnormality was found in the eye and orbit in the ocular CT examination.
Treatment
The child was admitted to the hospital for routine preoperative examinations, including routine blood work, coagulation, liver function, kidney function, and blood type, etc. After communicating with the family, we recommended frontal flap suspension and blepharoplasty. On the second day of admission, she was admitted to the operating room under general anesthesia for congenital ptosis correction (frontal flap suspension) combined with blepharoplasty of the right eye. The procedure went smoothly, and the right eye and right frontal area were covered with pressure after surgery, and the child returned to the ward safely after recovery from anesthesia.
Treatment results
The child was in good postoperative condition. On the first day of postoperative eye examination, the right upper eyelid was swollen with a small amount of subcutaneous bruising. In the first eye position, the upper lids of both eyes were symmetrical and equal in height. The skin sutures of the upper lid of the right eye were in place, the surgical incision was well aligned, there was no localized blood or exudate, the bulbar conjunctiva was mildly congested and edematous, there was no obvious discharge from the conjunctival sac, and the cornea was clear. The eye ointment was applied to prevent exposure keratitis and conjunctivitis, and the frontal area above the right eyebrow arch continued to be covered with elastic bandage and gauze block to prevent postoperative exudation and hematoma formation. On the second day after surgery, the gauze block was removed and the child recovered well. On the third day after surgery, the swelling was reduced and the sutures were in place, and the family was informed of postoperative matters.
IV. Notes
We are glad to see that the child has a normal appearance after the surgery, but the postoperative recovery is a long way to go, so we must follow the doctor’s prescription, eat lightly, rest more, and avoid watching electronic products for a long time.
1, after surgery, you need to take medication according to medical advice, apply levofloxacin hydrochloride eye gel to the right eyelid crack every night at bedtime to avoid exposure keratitis and conjunctivitis, train to close the eyes more every day, pay attention to hand hygiene, avoid hand rubbing eyes.
2. Do not eat spicy, stimulating and greasy food, drink more water, do more outdoor activities daily, reduce the use of electronic products, pay attention to eye habits, do not read, write, draw, etc. while lying down, lying down, walking or riding in a car. Eat less sweets and carbonated drinks, and eat more fresh vegetables and fruits, such as carrots, spinach, pumpkin, corn, blueberries, etc. Pay attention to work and rest, do not stay up late and ensure sufficient sleep.
3. Review and remove the stitches 10 days after surgery, review the vision regularly, and conduct amblyopia training, etc.
V. Personal insight
Congenital ptosis is a common eye disease in children and adolescents that affects vision development, appearance, etc. and can have a negative impact on the body and mind. In severe cases, surgery is usually recommended at the age of 3-4 to improve the condition, promote vision development, and prevent the development of form-deprivation amblyopia.