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Lids and Adnexa Class3 - Ptosis
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Lids and Adnexa Class3 - Ptosis

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www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. The third class in this series deals with blepheroptosis. The subtopics include …

www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. The third class in this series deals with blepheroptosis. The subtopics include diagnosis of ptosis, pseudoptosis, classification of ptosis into congenital and acquired ptosis and finally a brief discussion on the management of ptosis. Clinical features of congenital myogenic ptosis, Marcus jaw winking phenomenon, aponeurotic ptosis, neurogenic ptosis (III nerve palsy and Horner’s syndrome), CPEO, myasthenia gravis, traumatic and mechanical ptosis are explained.

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  • 1. Blepharoptosis
    Dr. Anupama Karanth
    www.ophthalclass.blogspot.com
  • 2. Drooping of upper eyelid
    Ptosis
  • 3. Diagnosis of ptosis
    Drooping of upper eyelid
    Palpebral fissure is narrowed
    Upper eyelid covers more than the normal 2 mm of cornea
    Brow elevation due to frontalisoveraction
    Chin up head posture in bilateral ptosis
  • 4. Does this patient have ptosis?
    Pseudoptosis - Phthisis bulbi ( left eye ) with cataract and iridocyclitis
  • 5. Pseudoptosis
    Enophthalmos
    Microphthalmos
    Phthisis bulbi
    Contralateral eye
    Hypertropia
    Eyelid retraction
  • 6. Types of ptosis
  • 7. Congenital ptosis
  • 8. Congenital ptosis
  • 9. Visual function in congenital ptosis
    Amblyopia is present in 20% of patients with congenital ptosis
  • 10. Marcus Gunn jaw winking ptosis
  • 11. Acquired ptosis
  • 12. Acquired ptosis
  • 13. Aponeuroticptosis
    Most common acquired ptosis
    • Usually age related
    • 14. Thinning or disinsertion of levatoraponeurosis
    • 15. Disinsertion from tarsal plate causes retraction of aponeurosis
  • Aponeuroticptosis
  • 16. Aponeuroticptosis
  • 17. Congenital Myogenic Vs Acquired AponeuroticPtosis
  • 18. Myogenicptosis
  • 19. Myogenicptosis
    At the level of the myoneural junction
    • Myasthenia gravis
    • 20. Ocular myasthenia
    At the level of the muscle
    • Myotonic dystrophy
    • 21. Chronic Progressive External Ophthalmoplegia (CPEO)
    • 22. Oculopharyngeal dystrophy
  • Muscular dystrophies
    CPEO
    • Bilateral symmetrical progressive ptosis
    • 23. Involvement of other extraocular muscles
    • 24. Pigmentary retinopathy
    • 25. Cardiac conduction abnormalities
    Myotonic dystrophy
    • Bilateral symmetrical progressive ptosis
    • 26. Christmas tree cataract
    • 27. Myopathicfacies
    • 28. Cardiac conduction abnormalities
  • Myasthenia gravis – Clinical features
    Fluctuating ptosis is the characteristic presentation
    • Autoimmune disorder
    • 29. Antibodies to acetylcholine receptors
    • 30. Easy fatiguability
    • 31. Life threatening symptoms – dysphagia, dyspnoea
  • Myasthenia gravis – diagnosis and treatment
    Treatment
    • Tensilon (Edrophonium chloride) test is the classical diagnostic test to confirm myasthenia
    • 32. IV antiacetylcholinesterase drug, ptosis improves on injection
    • 33. Other tests
    • 34. Ice pack test - improves ptosis
    • 35. Prolonged upgaze - worsens ptosis
    • 36. Rest / sleep test - improves ptosis
  • neurogenicptosis
  • 37. III nerve paralysisHorner’s syndrome
  • 38. Oculomotor nerve palsy
    Vasculopathic causes
    Compressive causes
    Aneurysm
    Neoplasm
    • Total or partial III nerve palsy
    • 44. Progressive symptoms
    • 45. Pupil involved
    • 46. Emergency workup
  • Oculomotor nerve palsy
  • 47. Oculosympathetic palsy ( Horner’s syndrome)
    Mild ptosis as a rule
    Causes
    • Intracranial aneurysm / tumor / inflammation
    • 51. Pancoast’s tumor / carotid aneurysms / malignant cervical lymph nodes
  • Traumatic PtosisMechanical Ptosis
  • 52. Traumatic ptosisfollowing orbital injury
  • 53. Mechanical ptosischalazion
  • 54. Mechanical ptosisplexiformneurofibroma
  • 55. Management of Ptosis
  • 56. Measurements in ptosis
    • Palpebral fissure height
    • 57. Marginal reflex distance
    • 58. Upper lid crease and fold
    • 59. Levator excursion
  • Levator function
  • 60. Surgical management
    Dependent on levator function