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Purpose: Since ptosis is an early feature of chronic progressive external ophthalmoplegia (CPEO), patients are commonly misdiagnosed with other causes of ptosis. This study aims to report the type and frequency of misdiagnosis and time lag to diagnosis and the palpebral fissure transfer (PFT) procedure in patients with CPEO. Methods: This is a retrospective analysis of consecutive patients with CPEO who underwent PFT between 2006 and 2017. The data on previous diagnoses and treatments, age at definitive diagnosis of CPEO, and clinical manifestations were recorded. While the diagnosis of CPEO was based on clinical examination, 75% (24/32) of patients had undergone a confirmatory muscle biopsy and genetic tests. Results: There were 32 patients (19 females) with a mean age of 24.8 years (range, 13--36) at the final diagnosis and 34.1 years (range, 15-56) at the time of PFT. Also, 78% (25/32) of patients had been initially misdiagnosed with congenital ptosis (60%; 15/25) and ocular myasthenia gravis (OMG) (40%; 10/25). The majority of patients (20/32) had one to three previous eyelid surgical procedures, of which 90% (18/20) were performed before the definitive diagnosis of CPEO. The mean time lag from the first surgical procedure to CPEO diagnosis and PFT was 6.2 and 14.7 years, respectively. Conclusion: In a referral center, 78% of the patients with CPEO were initially misdiagnosed with congenital ptosis and OMG, and 56% of them underwent ptosis repair before the diagnosis. While the onset of the disease was in the first or second decades of life, diagnosis was delayed up to a mean age of 25 years. Reviewing early family photos and paying attention to other signs of CPEO could prevent misdiagnosis. [ABSTRACT FROM AUTHOR]

There are two main techniques of lower blepharoplasty: transcutaneous and transconjunctival approaches. Most patients seeking lower eyelid rejuvenation have concomitant involutional changes in the lower eyelid and midface, which would better be addressed concurrently with the lower blepharoplasty procedure to yield better aesthetic and functional outcomes. This study aims to review common aging-related changes in the lower eyelid as well as important preoperative considerations, surgical techniques, and various modifications of lower blepharoplasty. A literature search was performed in the PubMed database of English-language journals without restriction on the publication date using selected keywords. The relevant articles were selected by reviewing the titles and abstracts. The lower eyelid and midface should be perceived as a continuum. Currently the fat preservation approach is the mainstream in lower blepharoplasty to prevent postoperative skeletonization of the eye. Fat transposition, via either pedicled fat flaps or free fat grafts, is used to efface tear trough deformity and the eyelid-cheek junction as a primary aim inaesthetic lower eyelid surgeries. Lower blepharoplasty can also be combined with adjuvant procedures to address festoon and droopy midface in selected individuals. [ABSTRACT FROM AUTHOR]

Competing Interests: Conflicts of Interest: Jamshidian-Tehrani M, None; Ghahvehchian H, None; Compton CJ, None; Clark JD, speaker for Horizon therapeutics; West NL, None; Kashkouli MB, None.

Susac syndrome is a microangiopathy of unknown origin, probably autoimmune, affecting capillaries and precapillary arterioles of the brain, retina, and inner ear. It is often misdiagnosed as acute disseminated encephalomyelitis or multiple sclerosis. We report the case of a 25-year-old male with Susac syndrome who developed the clinical triad of encephalopathy, visual and hearing problems over the course of a year. The characteristic MRI findings including central corpus callosal involvement and brain infarctions were supported by branch retinal arterial/arteriolar occlusions on fluorescein retinal angiography. Most patients with Susac syndrome will not have the complete clinical triad initially. A very high index of suspicion is required by the clinician and radiologist in patients with any component of the clinical triad so as not to misdiagnose the MRI findings for demyelination. Even if initial ophthalmologic examinations are normal, these patients should be followed up for later development of branch retinal artery occlusions.