2. ABNORAMAL DROOPING OF THE UPPER EYELID
UPPER EYELID COVERS ABOUT UPPER ONE –SIXTH
OF THE CORNEA .i.e., ABOUT 2 mm. THEREFORE, IN PTOSIS
IT COVERS MORE THAN 2mm.
4. (1) simple congenital ptosis (not associated
with any anomaly)
(2) congenital ptosis with associated
weakness of superior rectus muscle.
(3) As part of blepharophimosis syndrome,
which comprises congenital ptosis ,blepharophimosis
,telecanthus and epicanthus inversus.
(4)Congenital synkinetic ptosis (Marcus
Gunn Jaw –winking ptosis)
6. (1) NEROGENIC PTOSIS
caused by innovational defects such as third nerve
palsy, Horner’ syndrome, ophthalmoplegic migraine and
multiple sclerosis
Horner’s syndrome, is due to oculosympathetic paresis is
characterized by
(1) mild ptosis(due to paralysis of Muller’s
muscles)
(2) miosis (due to paralysis of dilator pupillae)
(3) Anhydrosis (reduced ipsilateral sweating )
(4) mild enophthalmos
(5) loss of ciliospinal reflex
8. (2) Myogenic
occurs due to acquired disorders of the LPS muscle
or myoneural junction.
Seen in patients with myasthenia gravis, dystropia
myotonica,ocular myopathy.
10. (3) Aponeurotic ptosis
It develops due to defects of the levator aponeurosis in the presence of
a normal functioning muscle .It includes;
(1) Involutional (senile ) ptosis
(2) postoperative ptosis (which is rarely observed after cataract and
retinal detachment surgery )
(3) ptosis due to aponeurotic weakness associated with
blepharochalasis and
(4) Traumatic dehiscence or disinsertion of the aponeurosis.
11.
12. Result due to excessive weight on the
upper lid as seen in patients with lid
tumors, multiple chalazia and lid oedema.
May occur due to scarring (cicatricial
ptosis) as seen in patients with ocular
pemphigoid and trachoma
13.
14. (1) HISTORY:
It should include age onset ,family history ,history of
trauma ,eye surgery and variability in degree of the ptosis.
(2) EXAMINATION:
(a) Exclude pseudoptosis(stimulated ptosis) on inspection
. Its common causes are:
Ipsilateral conditions such as microphthalmos,
phthisis bulbi , enophthalmos ,hypotropia
15. Contralateral condition include: eyelid
retraction ,high myopia and proptosis.
(2) OBSERVE THE FOLLOING POINTS IN EACH CASE:
(a) Whether ptosis is unilateral or bilateral.
(b) Function of orbicularis oculi muscle.
(c) Eyelid crease is present or absent.
(d) Jaw –winking phenomenon is present or not.
(e) Associated weakness of any extraocular
muscle.
(f) Bell’s phenomenon(up and outrolling of the
eyeball during forceful closure) is present or not
17. (3) MEASUREMENT OF AMOUNT(DEGREE) OF
PTOSIS:
(a) In case of unilateral ,difference between the
vertical height of the palpebral fissure of two sides
indicates the degree of ptosis.
(b) In bilateral cases it can be determined by
measuring the amount of cornea
covered by the upper lid and then subtracting 2 mm .
Ptosis is graded depending upon its amount as:
Mild ptosis = 2mm
Moderate ptosis = 3mm
Several ptosis = 4mm
20. (4) MARGIN REFLEX DISTANCE (MRD) REFERS TO THE
the distance between the upper lid margins and corneal light
reflex (of a pen torch held in front , on which patient is looking
) Normal value of MRD IS-5mm.
21. (5) ASSESMENT OF LEVATOR FUNCTION:
It is determined by lid excursion caused by LPS
muscle(Burke’s method ) .
Patient is asked to look down , and thumb of one hand is
placed firmly against the eyebrow of the patient( to block the
action of frontalis muscle )by the examiner.
Then the patient is asked to look up and the amount of
upper lid excursion is measured with a ruler held in the other
hand by examiner.
Levator function is graded as follows:
Normal : 15mm
Good : 8mm or more
Fair : 5-7 mm
poor : 4mm or less
22. 6 SPECIAL INVESTIGATIONS:
(1) Tensilon test :
Is performed when myasthenia is suspected.
(2) Phenylephrine test :
Is carried out in patients suspected of Horner’s syndrome.
(3) Neurological investigations
May be required to find out the cause in patient with
neurogenic ptosis
23. (7) PHOTOGRAPHIC RECORD
Of the patient should be maintained for comparison .
Photographs should be taken in primary position as well
as in up and down gazes.
24. (1) CONGENITAL PTOSIS
Always needs surgical correction .
In several ptosis , surgery should be performed at
earliest to prevent stimulus deprivation amblyopia.
In mild and moderate ptosis, surgery should be
delayed until the age of 3-4,when accurate
measurements are possible.
can be treated by any of the following operations:
25. (A) Tarso-conunctivo-Mullerctomy (Fasanella-Servat
operation):
It is performed in cases having mild ptosis(1.5-
2mm) and good levator function .
In it ,upper lid is everted and the upper tarsal
border along with its attached Muller’s muscle and
conjunctiva are resected.
(B) Levator resection:
Performed operation for moderate and several
grade of ptosis.
It is contraindicated in patients having several
ptosis with poor leavator function.
26. (C) Frontalis sling operation (Brow
suspension):
Performed in patients having severe ptosis with no
levator function:
(2) Acquired ptosis
(a) Treat the underlying cause where ever
possible.
(b) Conservative treatment should be carried
out and surgery deferred treatment at least for 6 months
in neurogenic ptosis.
(c) Surgical procedure (when required)
