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Etiology of eyelid retraction in children: a retrospective study
1Department of Ophthalmology, University of Southern California School of Medicine, Los Angeles.
Insights
Eyelid retraction in children often has an unclear cause. This study identified causes like nerve issues, fibrosis, and thyroid problems, recommending specific diagnostic tests for accurate diagnosis.
Area of Science:
- Ophthalmology
- Pediatric Neurology
Background:
- Eyelid retraction in adults is commonly linked to Graves' ophthalmopathy.
- Causes of eyelid retraction in children are less understood and rarely reported.
Purpose of the Study:
- To review the relative frequency of various etiologies of eyelid retraction in pediatric patients.
- To identify common causes and recommend diagnostic approaches for childhood eyelid retraction.
Main Methods:
- Retrospective review of medical records for 16 pediatric patients with eyelid retraction from 1976 to 1991.
- Analysis of unilateral and bilateral cases to determine associated etiologies.
- Evaluation of diagnostic yield from imaging studies.
Main Results:
- Identified five distinct causes for eyelid retraction in children.
- Unilateral retraction was linked to third nerve palsy, levator fibrosis, hemangioma, hyperthyroidism, craniosynostosis, and Down syndrome.
- Bilateral retraction was associated with hyperthyroidism or optic nerve anomalies.
Conclusions:
- Thyroid evaluation is recommended for pediatric eyelid retraction without aberrant innervation.
- Neuroimaging should be considered if thyroid function tests are normal.
- Further investigation is needed for cases with incomplete evaluations.
Abstract:
Eyelid retraction in an adult occurs usually secondary to Graves' ophthalmopathy, but in children the diagnosis is often obscure. To our knowledge, there are no reports reviewing the relative frequency of the various etiologies of eyelid retraction in children. We reviewed the records of our Pediatric Service from 1976 to 1991 and identified 16 children with eyelid retraction. The eyelid retractions were unilateral in 11 cases and bilateral in five cases, and were the result of five different identifiable causes. Unilateral eyelid retraction was associated with congenital aberrant innervation of the third nerve (3), levator fibrosis (2), hemangioma (1), hyperthyroidism (1), craniosynostosis (1) and Down syndrome (1). Bilateral eyelid retraction was associated with either hyperthyroidism (2) or bilateral optic nerve anomalies with vertical nystagmus (2). Seven of our 11 patients with unilateral retraction had an identifiable etiology, and the remaining four patients had incomplete evaluations. Imaging studies were diagnostic in four of nine patients so studied. Based on our findings, we recommend thyroid studies in all patients with eyelid retraction without aberrant innervation, and neuroimaging if thyroid function is normal.