Vincristine‐induced unilateral ptosis

Purpose To report the ocurrence of an unilateral ptosis in a 2‐year‐old girl treated by vincristine for a vaginal rhabdomyosarcoma. Methods Our young patient developed a vaginal rhabdomyosarcoma and had been treated by chemotherapy (Ifosfamide‐Vincristine‐Actinomycine) when an unilateral ptosis occurred 7 days after the fifth vincristine dose (1.5 mg/m2). At that time, cumulative vincristine dose was 4.50 mg. Neither oculomotor dysfunction nor anisocoria were present. Neurological and systemic examinations were otherwise unremarkable. Laboratory testing and thoracic‐cervical‐cranial scan were normal. Other causes of ptosis were excluded. Despite vincristine dose was reduced by a third, ptosis slightly increased after the 2 subsequent injections but decreased between cures. Ptosis disappeared at day 78 and no recurrence was noticed after the treatment continuation at the same dose. Results Neurotoxicity is a well‐known complication of vincaalkaloids. Bilateral ptosis is relatively common but reported cases of vincristine‐induced unilateral ptosis are infrequent. In our young patient, occurrence of the ptosis during treatment, increase during new infusions of vincristine and exclusion of other aetiologies are forceful arguments to consider the role of vincristine in this side effect. The use of pyridoxine or pyridostigmine were suggested to treat vincristine‐induced cranial neuropathies but to date, the benefit remains unproved. Adaptation of treatment regimen must be done. In our case dose reduction allowed disappearance of the ptosis. Conclusion Even if unilateral ptosis is rare among vincristine‐induced neurological complications, ophthalmologists must be aware of this diagnosis.