Ptosis and Orbital Fat Prolapse after Posterior Sub–Tenon’s Capsule Triamcinolone Injection
Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, April, 2004; Ft. Lauderdale, Florida.
Received 12 July 2004; accepted 10 January 2005. published online 09 May 2005.
Purpose
To describe the occurrence of orbital fat prolapse and blepharoptosis after posterior sub-Tenon (PST) triamcinolone injection.
Design
Retrospective review of consecutive case series.
Participants
Patients with ptosis and orbital fat herniation after PST triamcinolone injection.
Methods
Charts of all patients with ptosis and orbital fat herniation presenting after PST triamcinolone injection to the oculoplastics service of the Cole Eye Institute between 1999 and 2003 were reviewed. Charts were reviewed for patient age, indication, dates of injections, time to patient complaint or time to referral for ptosis, and marginal reflex distance (MRD1).
Main Outcome Measures
Ptosis and orbital fat herniation after PST triamcinolone injection.
Results
Eleven patients with a history of ipsilateral PST triamcinolone injections were seen with ptosis and orbital fat prolapse. Ten charts were available for review. Mean patient age was 64 years (range, 45–78 years). Patients underwent 1 to 9 ipsilateral injections, and 2 patients underwent bilateral injections. Patients were seen for ptosis evaluation on average 22.5 months (range, 3–56 months) after the initial injection, and 6.6 months (range, 0–20 months) after the most recent injection. All patients demonstrated significant orbital fat prolapse in conjunction with statistically significant ptosis (P = 0.016). Tissue was obtained in 3 cases. Histologic findings in 1 case showed orbital fat infiltrated by histiocytes that seemed to contain phagocytosed material.
Conclusions
Posterior sub-Tenon triamcinolone injection may cause ptosis associated with orbital fat prolapse. This finding may be a relatively common complication of PST triamcinolone injection. We recommend counseling patients about this risk before PST triamcinolone injection.
1Division of Ophthalmology, Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio.
2Division of Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence and reprint requests to Julian D. Perry, MD, Division of Ophthalmology, Cole Eye Institute, Desk I-32, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Manuscript no. 240551.
The authors have no commercial or proprietary interest in any product or corporation mentioned in the article.
ABSTRACT