Adult ptosis
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Introduction to the importance, evaluation and interpretation of physical finding in patients with ptosis
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Keratoconus is a progressive disorder where the cornea thins and protrudes into a cone shape, usually developing during puberty and progressing until the 3rd-4th decades. It affects both eyes and causes vision impairment from irregular astigmatism and myopia. Diagnosis involves examining for signs of stromal thinning, protrusion, striae, Fleischer ring, and steep keratometry readings. Treatment ranges from glasses and contact lenses in early stages to keratoplasty for severe scarring.
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The document discusses the anatomy and clinical examination of the cornea. It contains the following key points:
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This document provides an overview of angle closure glaucoma, including anatomy, pathophysiology, diagnosis, and treatment. It begins with a description of the relevant anatomy - the ciliary body, anterior chamber angle, trabecular meshwork, Schlemm's canal. It then discusses intraocular pressure and aqueous humor dynamics. The pathophysiology section defines primary and secondary angle closure glaucoma. Diagnosis involves evaluating the history, ocular examination including gonioscopy and optic nerve/visual field testing. Treatment goals are to lower IOP, preserve vision and prevent further visual field loss through medical management such as medications or surgical options like trabeculectomy or laser procedures.
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Dry eye disease (DED) is a condition caused by many factors that result in inflammation of the eye and the tear-producing glands.
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- It typically affects people in their mid-60s and is more common in men.
- Embolism, usually from the heart or carotid artery, is the most common cause.
- Symptoms include sudden severe vision loss in one eye. On examination, the retina appears opaque and edematous with a narrowed artery.
- Visual loss is usually permanent if not treated within 90 minutes. Prompt diagnosis and treatment aimed at dissolving the clot are needed to preserve vision.
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The document discusses the anatomy and clinical examination of the cornea. It contains the following key points:
1) The cornea has 5 layers - an epithelium, Bowman's membrane, a thick stromal layer, Descemet's membrane, and an endothelium. The stroma comprises 90% of the corneal thickness and contains collagen fibrils.
2) The cornea receives its nerve supply from the ophthalmic division of the trigeminal nerve via the nasociliary nerve. Clinical tests like the corneal reflex test examine the integrity of these nerve pathways.
3) Common corneal pathologies include infections like herpes simplex keratitis and acanthamoeba keratitis.
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The document discusses evaluation of the optic nerve head and retinal nerve fiber layer. It provides details on the anatomy and characteristics examined, including the intra-papillary and para-papillary regions. Glaucomatous damage results in characteristic signs in these areas like retinal nerve fiber layer defects. Newer imaging techniques like stereo-photogrammetry, scanning laser technologies, and optical coherence tomography (OCT) allow for early diagnosis by focusing on the retinal nerve fiber layer and optic disc. OCT is particularly useful for evaluating pre-perimetric glaucoma and monitoring macular changes.
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Graves' ophthalmopathy, also known as thyroid eye disease, is an inflammatory disorder affecting the eye muscles and surrounding tissues that is associated with Graves' disease and hyperthyroidism. Symptoms include bulging or protruding eyes, eyelid retraction, double vision, and potential vision loss if left untreated. The condition results from antibodies that cause swelling of eye muscles and tissues. Diagnosis involves examination of the eyes and imaging tests. Treatment focuses on medications and surgery to reduce swelling and pressure on the eyes.
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The document summarizes various ocular manifestations of systemic diseases. It discusses how conditions like diabetes, hypertension, sarcoidosis, thyroid disease, and infections can present with issues like uveitis, cataracts, retinal vessel abnormalities, proptosis, ptosis, and abnormal eye movements. It provides details on characteristic signs, potential etiologies, and implications for underlying systemic illnesses for each type of ocular presentation.
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This document discusses various disorders of the crystalline lens, including disorders of lens shape and position such as coloboma, lenticonus, lentiglobus, microphakia, and ectopia lentis. It also discusses cataracts, providing classifications based on age, stage, morphology, etiology, and associations with ocular and systemic diseases. Specific lens disorders are described in detail, along with risk factors and pathologies of various types of cataracts.
Dd of disc edema
1. A 41-year-old man presented with blurred disc margins and was found to have reactive syphilis serology, indicating neurosyphilis presenting as asymptomatic optic perineuritis.
2. A 9-year-old boy presented with intermittent headaches and abdominal pain and was found to have bilateral optic disc swelling and markedly elevated blood pressure, leading to the diagnosis of a pheochromocytoma.
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Written By - Kh. Md .Imrul Morshed
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This document discusses optic disc changes in glaucoma. It defines key terms like optic nerve head and lamina cribrosa. It describes physiological cupping and normal cup-to-disc ratios. Pathogenesis of optic nerve head changes in glaucoma involves mechanical effects of increased intraocular pressure and vascular effects of ischemia. Signs suggestive of glaucoma include increased cup size, asymmetry between eyes, thinning of the neuroretinal rim, notches, splinter hemorrhages, and retinal nerve fiber layer defects preceding other changes. Advanced glaucoma shows total cupping and bending of retinal vessels at the disc margin.
Ptosis
This document discusses different types of ptosis (drooping of the upper eyelid), including neurogenic, myogenic, aponeurotic, mechanical, congenital, traumatic, and involutional ptosis. It describes how to clinically evaluate ptosis by taking a patient history and performing measurements of the eyelid. Specific types of ptosis like Marcus Gunn Jaw-Winking Syndrome and simple congenital ptosis are explained. Surgical treatment options are provided depending on the type and severity of ptosis.
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Dry eye is a disease of the tear film and ocular surface caused by reduced tear production or increased tear evaporation. It results in eye discomfort, visual disturbance, and potential ocular surface damage. Dry eye can be caused by problems with the lacrimal functional unit such as aging, autoimmune disease like Sjogren's syndrome, or environmental factors. Diagnosis involves evaluating tear production via tests like Schirmer's test and tear breakup time, and assessing ocular surface staining. Treatment depends on dry eye severity and may include artificial tears, anti-inflammatories, punctal plugs, and management of underlying conditions. The goal is to supplement tears, reduce evaporation, stimulate natural tear production, and minimize
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Pinguecula is a common degenerative condition of the conjunctiva that presents as a yellowish white patch near the limbus. It is caused by elastotic degeneration of collagen fibers and deposition of hyaline material in the conjunctiva due to repeated exposure to UV radiation. Pinguecula typically affects males over age 40 who spend significant time outdoors without adequate eye protection. While usually asymptomatic, larger pinguecula can cause irritation, interfere with contact lens wear, or become inflamed. Treatment involves lubrication for irritation and excision only if the pinguecula causes cosmetic or fitting issues.
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Dry eye is a disease of the ocular surface caused by disturbances in the tear film. The normal tear film consists of an inner mucin layer, middle aqueous layer, and outer lipid layer, which work together to form a stable tear film. Disruptions to the tear film components or their functions can lead to dry eye. Common tests to diagnose dry eye include tear break-up time, fluorescein clearance, and tear osmolarity measurement, which help identify tear film instability and inflammation associated with the condition.
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This document summarizes a case of a 78-year-old female who presented with decreased vision in her right eye. On examination, her vision in the right eye was measured at 20/100 and counting fingers in the left eye. Imaging and labs revealed chronic lacunar infarcts and no signs of infection or inflammation. The patient was diagnosed with anterior ischemic optic neuropathy and started on steroid treatment.
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This document discusses congenital ptosis, including its types, causes, signs, and treatments. There are several types of congenital ptosis, including simple congenital ptosis which is not associated with other anomalies, ptosis associated with weakness of the superior rectus muscle, and blepharophimosis syndrome where ptosis occurs with additional facial features. Congenital ptosis is caused by underdevelopment of the levator palpebrae superioris muscle. Treatment depends on the severity of ptosis and amount of levator function, and may include conjunctiva-Müller resection for mild ptosis, levator resection for moderate ptosis with sufficient levator function, or brow suspension for severe ptosis with poor
Ptosis
This document discusses ptosis, or drooping of the upper eyelid. It defines ptosis as the upper eyelid covering more than 2mm of the cornea. The document describes the different types of ptosis, including congenital, acquired, neurogenic, myogenic, aponeurotic, and mechanical. It also covers examinations for ptosis including measurements of marginal reflex distance, vertical fissure height, upper lid crease, and pretarsal show. The document discusses treatments for ptosis such as the Fasanella-Servat procedure, levator resection, and frontalis brow suspension.
Ptosis
This document discusses ptosis, or drooping of the upper eyelid. It defines ptosis as the upper eyelid covering more than 2mm of the cornea. There are two main types - congenital and acquired. Congenital ptosis can be further divided into simple congenital ptosis, Blepharophimosis syndrome, and Marcus Gunn jaw winking ptosis. Acquired ptosis has causes such as neurogenic (Horner's syndrome, third nerve palsy), myogenic (ocular myasthenia), aponeurotic, or mechanical. Examination of ptosis evaluates the degree using measurements like marginal reflex distance and levator function. Treatment depends on the type and severity of
Ptosis
This document discusses ptosis, or drooping of the eyelid. It begins by describing the functional anatomy of the levator palpebrae superioris muscle and other muscles involved in eyelid elevation. It then defines ptosis and classifies it as congenital or acquired, with the acquired category further divided into neurogenic, myogenic, aponeurotic, mechanical, and neurotoxic causes. Several types of congenital ptosis are described in detail, including blepharophimosis syndrome and Marcus Gunn jaw-winking syndrome. Evaluation of ptosis involves assessing history, appearance of eyelids at rest, levator function testing, and identifying associated signs. Investigations may include imaging or blood tests depending on
Ptosis
Ptosis, or drooping of the eyelid, can be congenital or acquired. The main causes of acquired ptosis are neurogenic (issues with nerve supply), myogenic (problems in the levator palpebrae superioris muscle or myoneural junction), or aponeurotic (defects in the levator aponeurosis). Clinical evaluation of ptosis involves measuring the severity using marginal reflex distance and assessing levator function by having the patient look up and down. Mild ptosis is 2mm of droop, moderate is 3-4mm, and severe is over 4mm. Treatment depends on levator function and may include frontalis sling if function is poor, or levator
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This document discusses various surgical techniques for treating ptosis including modified Fasanella-Servat procedure, levator resection, and tarsofrontalis sling. It provides details on patient evaluation, surgical steps, guidelines for amount of levator resection, and potential complications. The modified Fasanella-Servat procedure involves tarso-conjunctival mullerectomy and is best for mild congenital ptosis. Levator resection is performed through skin or transcutaneous approaches. A tarsofrontalis sling uses silicone or fascia and is ideal for bilateral or severe ptosis. Potential complications include under or overcorrection, contour abnormalities, crease issues, and conjunctival prolapse.
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This document provides an overview of ptosis, or drooping of the upper eyelid. It defines ptosis and classifies it as either congenital or acquired, with mechanisms including neurogenic, myogenic, aponeurotic, or mechanical causes. It describes measurements used in diagnosis such as margin-reflex distance, palpebral fissure height, levator function, upper eyelid crease, and lagophthalmos. Common types of ptosis like congenital, Marcus Gunn jaw-winking syndrome, and involutional are explained. Differential diagnosis and management options including non-surgical and surgical treatments like eyelid crutches, levator advancement, resection, and frontalis suspension are summarized
Ptosis
This document provides information on how to evaluate blepharoptosis (drooping of the upper eyelid) clinically. It discusses classifications of ptosis as congenital or acquired. Evaluation involves measuring eyelid positions, assessing levator function and other muscle movements. Tests like phenylephrine, ice and edrophonium help determine the cause. Thorough history, examination and documentation including photographs are needed before considering surgical management of ptosis.
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The document discusses multiple sclerosis (MS), including its anatomy, physiology, pathogenesis, types, symptoms, diagnosis and treatment. MS is a chronic inflammatory demyelinating disease of the central nervous system. It results from an immune-mediated process causing inflammation, demyelination and axonal loss. There are four main types but the most common is relapsing remitting MS, characterized by temporary flare-ups followed by periods of remission. Symptoms vary depending on location of lesions but may include sensory issues, weakness, visual problems, coordination difficulties and more. Diagnosis involves clinical criteria and tests like MRI and lumbar puncture. Treatment focuses on managing relapses, reducing disease activity and controlling symptoms.
Trochlear nerve
This document provides an overview of the trochlear nerve (cranial nerve IV), which innervates the superior oblique eye muscle. It discusses the anatomy and course of the nerve from its nucleus in the midbrain through the skull and orbit. Key points include that the trochlear nerve is the only cranial nerve to decussate and has the longest intracranial course. Causes of trochlear nerve palsy include congenital issues, trauma, vascular problems, and tumors. Clinical features of trochlear nerve palsy are hyperdeviation of the eye, limited eye movements, diplopia, and abnormal head posture. The document also outlines tests to diagnose trochlear nerve pals
Real ptosis evaluation.pptx
This document provides an overview of blepharoptosis (ptosis) including its classification, evaluation, and case study. It begins with an introduction to ptosis and eyelid anatomy. It then covers the types of ptosis such as congenital, acquired, and pseudo ptosis. The evaluation section details the history taking, inspection, measurements including levator function, margin reflex distance, and margin crease distance. It also discusses ancillary tests and differential diagnosis. Overall, the document serves as a guide for clinicians to classify and evaluate different types of ptosis.
PTOSIS.pptx
you will get knowledge about the ptosis, its different types, its examination, its measurement, its treatment in detail.
different eyelid muscles such as LPS, Orbicularis oculi and frontalis are also explained.
Third nerve palsy.pptx
The oculomotor nucleus complex present in the midbrain, at the level of the superior colliculus
Contains Main motor nucleus and Accessory parasympathetic nucleus (Edinger-Westphal nucleus)
Fibers pass between the posterior cerebral artery and the superior cerebellar artery to reach the cavernous sinus.
During this course, the oculomotor nerve lies lateral to the posterior communicating artery.
The nerve then divides into a superior and inferior division and enters the orbit through the superior orbital fissure
Third nerve palsy results from dysfunction of the nerve along its pathway from the midbrain to the extraocular muscles it innervates.
Third nerve palsies can cause dysfunction of the somatic muscles (SR ,IR,MR,IO, levator palpebral superioris) and autonomic muscles (the pupillary sphincter and ciliary muscle.)
classification
1. Complete or incomplete palsy
Complete: Involves both superior and inferior divisions of the nerve.
Incomplete: Involves superior division, inferior division (rarely), or an isolated muscle
2. Total palsy or partial paresis
● Total: Full restriction of extraocular muscles is present.
● Partial: Restriction of extraocular muscles is limited.
3. Pupil-involving or pupil-sparing palsy
● Pupil involving: Pupil is dilated, with an accommodative insufficiency.
● Pupil sparing: Pupil and accommodative function are normal.
Nerve supply of head and neck
This document provides an overview of the 12 cranial nerves, including their origin, nuclei, course, branches, and clinical considerations. It discusses each cranial nerve individually, from CN I (Olfactory) through CN XII (Hypoglossal). For each nerve, it describes the embryonic development, key anatomical structures it is associated with or passes through, the structures it innervates, and clinical implications of damage to that nerve. The overall purpose is to review the nerve supply of the head and neck region through detailed examination of each cranial nerve.
Pupil
The pupil is a circular opening located in the center of the iris that controls the amount of light entering the eye to ensure optimal vision. Key characteristics of a normal pupil include being equal in size and round between both eyes. Abnormal pupils can be too small (miosis) or too large (mydriasis) and may be caused by medical conditions, drugs, or neurological disorders. Doctors examine the pupil's size, shape, equality, reaction to light, and accommodation to evaluate for any abnormalities.
Spinal cord disorders
This document discusses spinal cord disorders and provides information on spinal cord anatomy and different types of spinal cord injuries and conditions. It outlines 15 questions regarding the anatomy of the spinal cord and characteristics of various spinal cord disorders including central cord syndrome, Brown-Sequard syndrome, anterior cord syndrome, transverse myelitis, syringomyelia, spinal epidural hematoma, spinal epidural abscess, diskitis, and spinal cord neoplasms. The document seeks to test the reader's knowledge on the topics covered through true or false questions.
Neuro ophthalmology 2016
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Module 4 cranial nerve
The document provides an overview of the 12 cranial nerves, their functions, and potential disorders. It focuses on describing Cranial Nerves I-III in detail:
Cranial Nerve I (Olfactory) is responsible for smell. Anosmia is the loss of sense of smell.
Cranial Nerve II (Optic) is responsible for vision. Disorders include myopia, amblyopia, presbyopia, and color blindness.
Cranial Nerve III (Occulomotor) controls extraocular eye movements and the pupil.
Oculomotor Nerve
The oculomotor nerve (CN III) controls most of the extraocular muscles as well as the levator palpebrae superioris muscle and the sphincter pupillae and ciliary muscles. It has somatic and parasympathetic components. The somatic component innervates the extraocular muscles and levator palpebrae superioris. The parasympathetic component controls pupil constriction and accommodation through the ciliary ganglion. Damage to different parts of CN III can cause disorders of eye movement, eyelid position, and pupil function.
Ultrasound image gallery
ADACTYLY IN FETUS
PORENCEPHALIC CYST IN FETUS
SEPTO-OPTIC DYSPLASIA IN FETUS
MUSCLE HERNIA IN ADULT
FETAL REDUCTION
AGENESIS OF CORPUS CALLOSUM
FLAT FETAL FACIAL PROFILE
Pupil Basic.....
The pupil is a hole located in the centre of the iris that allows light to enter the retina. The iris contains muscles that control the size of the pupil in response to light and focusing. Anisocoria is when the pupils are unequal sizes and can be caused by physiological factors, trauma, inflammation, or neurological issues. Examining the pupils' reaction to light and focusing is important for evaluating eye and neurological function.
Horner syndrome. Horner's syndrome
Horner syndrome results from disruption of the sympathetic nerve supply to the eye. It is characterized by three key signs: ptosis, miosis, and anhidrosis. The syndrome can be classified based on where along the sympathetic pathway the disruption occurs. Testing involves confirming the diagnosis with apraclonidine, which causes reversal of miosis and ptosis in denervated eyes. Investigations depend on classification and may include imaging of the brain, cervical spine, chest, or neck vessels to identify underlying causes.
SYBPO - Orthotics - AIIPMR notes - Orthotic knee joints
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Diseases of the spinal cord
This document discusses diseases of the spinal cord, including spinal cord compression and myelopathy. It provides details on:
1. The clinical presentation of spinal cord compression, including pain, weakness, and sphincter disturbances. Brown-Sequard syndrome is described.
2. Causes and examples of myelopathy, including transverse myelitis and multiple sclerosis.
3. Specific spinal cord syndromes like paraplegia are outlined, detailing stages like spinal shock. Cervical disc herniation is also summarized.
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SYBPO - Orthotics - AIIPMR notes - Orthotic knee joints
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Adult ptosis
- 1. Adult Ptosis RANDY M ROSENBERG MD FAAN FACP ASSISTANT PROFESSOR OF NEUROLOGY LEWIS KATZ SCHOOL OF MEDICINE AT TEMPLE UNIVERSITY
- 2. Functional Anatomy Levator palpebrae superioris Primary muscle for lid elevation Arises from the back of the orbit and extends forwards over the cone of eye muscles Inserts into the eyelid and the tarsal plate, a fibrous semicircular structure which gives the upper eyelid its shape Innervated by the superior division of the oculomotor nerve Muller’s muscles (superior tarsal muscle) Involuntary muscles comprising sympathetically innervated smooth muscle Has the capacity to “tighten” the attachment and raise the lid a few millimeters (1-3mm of lid retraction)
- 3. Functional Anatomy Frontalis muscle and Obicularis oculi Frontalis elevates the eyelid indirectly Note George’s frontal wrinkles Obicularis oculi depresses eyelid Both are innervated by CN VII
- 4. Normal Lids Normal eyelid excursion is 13 mm The right-sided image shows: a normal eyelid crease (A), upper marginal reflex distance (B) Margin to reflex distance is normally 4-5 mm palpebral fissure (C) Vertical fissure height is normally 9-10 mm
- 5. Left Sided Ptosis Lid crease is absent on the left The crease is up in the sulcus Superior sulcus deformity is present on the left and right, and the patient is elevating her brows. The right upper lid should be checked for an underlying or masked ptosis. If the right lid is ptotic, lifting the left lid causes the right lid to droop.
- 6. Simple Bedside Evaluations of Ptosis Law of Reciprocal Innervation
- 7. CN III Palsy Dense Ptosis due to paresis of LPS Pupillary sparing Pupilloconstrictor fibers of externally located and vunlnerable to compression Deep disease of CN III such as ischemia (e.g. diabetes microangiopathy, granulomatous arteritis) often spares pupil
- 8. Horner’s Syndrome Classic triad: Unilateral ptosis Ipsilateral miosis (mild) Anhidrosis Sudomotor fibers peal off at bifurcation of the carotid Anisocoric is worse in the dark Oculosympathetic paresis is dysfunction is one of a three order neuron pathway
- 9. Cranial Sympathetics: A Three Neuronal Pathway
- 10. Pharmacologic Testing In Horner’s Syndrome
- 11. Apraclonidine Eyedrop Testing in Horner’s Syndrome Will quickly determine if a Horner’s is present but does not distinguish between pre- and post- ganglionic etiology
- 12. Paradigm for Acute Horner’s
- 13. Congenital Ptosis Most cases are due to localized myogenic dysgenesis. The levator muscle and aponeurosis tissues appear to be infiltrated or replaced by fat and fibrous tissue. Frequently the superior rectus will be involved 70% involve only one eye Most cases are noted at birth but may manifest by the 1st year of life Note the presence of a lid crease. Note the upward chin tilt
- 14. Elements in the Examination of Congenital Ptosis
- 15. Marcus Gunn Jaw Winking Phenomenon Neurogenic ptosis Usually from congenital ptosis Involves motor component of CN V and superior division of CN III ?Aberrant reinnervation Lid elevates with jaw movement
- 16. Ptosis in Myasthenia Gravis ◦Ptosis with sustained up-gaze Lid twitch (Cogan's lid twitch sign) With down-gaze to up-gaze Lid elevates excessively & then droops again Unilateral or Bilateral Worse side may vary from day to day Worse with sustained up gaze Improved with cold
- 17. Ocular Myasthenia Myogenic ptosis Causes of myogenic ptosis Myasthenia Chronic progressive external ophthalmoplegia Oculopharyngeal dystrophy Other dystrophies including myotonic Ice test 2 minutes and >2 mm