PMC9063448_01
Serial photos of Case 1 before and after frontalis-orbicularis oculi muscle (FOOM) flap shortening surgery and injection of botulinum toxin-A. (A) Photos were taken before and (B) 3 months after FOOM flap shortening, respectively. (C,D) The FOOM flap function (upper eyelid excursion) of the right eye was about 4 mm 1 year after FOOM flap shortening. (E,F) The FOOM flap function was reduced to nearly 0 mm 1 week after the injection of botulinum toxin-A with 5 units at the central supra-brow area, which was supposed to be the area around the origin of the FOOM flap. (G) 1 week after the injection, he developed blepharoptosis. (H) The patient could close his eyes completely without lagophthalmos.
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F2
A 63-year-old gentleman developed complete blepharoptosis for 6 months after surgery for an orbital lymphoma in the right eye (Figure 2A). We performed FOOM flap shortening, after which he obtained a symmetric appearance (Figure 2B). The margin reflex distance 1 (MRD1) was 2.5 mm, and the function of FOOM flap (upper eyelid excursion) was 4 mm postoperatively (Figures 2C,D). One week later, he developed blepharoptosis with MRD1 of 1 mm and the function of FOOM flap was reduced from 4 mm to nearly 0 (Figures 2E-H).
The blepharoptosis recovered with margin reflex distance 1 (MRD1) measured 2.5 mm 3 months after the injection.
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F3
He recovered from the ptosis with MRD1 of 2.5 mm 3 months after the injection (Figure 3) and did not require a second injection even after 1 year.
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