Ptosis and orbital fat prolapse after posterior sub-Tenon's capsule triamcinolone injection.
OBJECTIVE
To describe the occurrence of orbital fat prolapse and blepharoptosis after posterior sub-Tenon (PST) triamcinolone injection.


METHODS
Retrospective review of consecutive case series.


METHODS
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).


METHODS
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.
Dal Canto
Albert J
AJ
Division of Ophthalmology, Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Downs-Kelly
Erinn
E
Perry
Julian D
JD
D000273:Adipose Tissue; D000368:Aged; D001763:Blepharoptosis / Q000139:chemically induced* / Q000473:pathology; D003238:Connective Tissue; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D007267:Injections; D008068:Lipomatosis / Q000139:chemically induced* / Q000473:pathology; D008875:Middle Aged; D009916:Orbital Diseases / Q000139:chemically induced* / Q000473:pathology; D011391:Prolapse; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000009:adverse effects*
D005938:Glucocorticoids; D014222:Triamcinolone Acetonide