This 75yr old was an avid cyclist🚴♀️ , swimmer 🏊♀️ and Yoga 🧘 practitioner. He has been severely restricted from regular activities due to his bilateral ptosis. He was suffering from Chronic Progressive External Opthalmoplegia (CPEO). It is a genetic condition that affects patients mainly in the second half of their lives. His two elder brothers too suffered ptosis without getting it corrected and passed on without relief.
Chronic progressive external ophthalmoplegia (CPEO) describes an spectrum of hereditary myopathies affecting extraocular muscles (EOMs) commonly manifesting as bilateral ptosis and near total external ophthalmoplegia.
As the name suggests, it is a chronic, progressive, bilateral, typically symmetric, and external (i.e., spares the pupil) ophthalmoplegia. CPEO is associated with mitochondrial disease and can occur as isolated oculomotor symptoms (isolated CPEO) or in conjunction with other systemic findings (“CPEO-plus”). Depending on additional clinical features, CPEO can be evaluated as part of a systemic myopathic or neurologic syndrome
Surgical correction of Myogenic Ptosis like in CPEO is challenging as conventional methods cannot tackle this condition safely as both opening and closure of eyelids is compromised in this condition.
However, this gentleman proved to be luckier than his elder brothers. When he approached me, I told him about the technique I was experimenting with which was having acceptable results- Tarsal Switch technique for correction of severe myogenic ptosis. He agreed to go ahead despite a detailed counselling mentioning that there might be chances it may not work in everyone who has CPEO. He told me, “he had nothing to lose, even if I have a 50% chance I’ll accept it”.
Post surgery, the surgery was a success-as can be seen by the photo collage above. We were able to achieve clearance of the central visual field. The patient is thrilled at the results and is back to his previous active lifestyle 🧘🚴♀️🏊♂️.
My experience over the past 2+ years with this technique has been gratifying and I have made some modifications to the techniques described in the literature. I’m surprised why this technique is not being offered more frequently.
⏲Surgery time: 45mins per side
💉Anaesthesia: Done under Local with or without sedation
🗓️Downtime: 3-4 weeks
📈Duration of effect: Long term
📠 Phone: +91 80 2502 3257
📩 E-mail: raghuraj@drraghurajhegde.com
🖥️ Website: www.drraghurajhegde.com
©All patient photos are being used with the express consent of the patient. These cannot be shared or reproduced elsewhere.
DR. RAGHURAJ HEGDE 