Evaluation of ptosis
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This document discusses the evaluation of ptosis, or drooping of the eyelids. It begins by defining ptosis and distinguishing between true and pseudo ptosis. True ptosis is classified as acquired or congenital, with acquired further divided into neurogenic, myogenic, aponeurotic, and mechanical types. The evaluation of ptosis involves a thorough history, measurement of margin-reflex distance, palpebral fissure height, levator function, and upper lid crease. Additional tests include assessing for fatigability, Cogan's twitch sign, and jaw winking phenomenon. Confirmatory tests include the ice test and edrophonium (Tensilon) test. Treatment options mentioned include eyelid
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Ptosis: Clinical Anatomy, Diagnosis and Management
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Physiology of the Eyelids and Lacrimal Pump/ Methods of Examination
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Evaluation of ptosis
- 1. EVALUATION OF PTOSIS BY DR NIKITA JAISWAL MS RESIDENT IMS AND SUM HOSPITAL
- 2. BLEPHAROPTOSIS OR PTOSIS:ABNORMALLY LOW POSITION OF UL IN PRIMARY GAZE IN NORMAL GAZE IT COVERS 1/6TH OF THE CORNEA, I.E 2 MM . IN PTOSIS IT COVERS MORE THAN THAT. PTOSIS {DERIVED FROM: GREEK LANG.} MEANS : TO FALL Mr bell clicked it in 1952
- 3. BEFORE ANY JUDGEMENT WE NEED TO DIFFERENTIATE BETWEEN :- PSEUDOPTOSIS[SIMULATED PTOSIS} TRUEPTOSIS
- 4. PSEUDOPTOSIS :IT IS TO BE RULED OUT ON INSPECTION IPSILATERAL CONDN: MICROPHTHALMOS PTHISIS BULBI ENOPHTHALMOS PROSTHESIS DERMATOCHALASIS CONTRALATERAL CONDN: EYELID RETRACTION HIGH MYOPIA PROPTOSIS
- 8. PRESENTING COMPLAINTS OF THE PATIENT Drooping of the eyelids since a definite period Associated decreased vision unaware of the eyelids
- 9. GRADING: MILD PTOSIS: 2MM MODERATE PTOSIS: 3 MM SEVERE PTOSIS : 4 MM
- 10. EVALUATION
- 11. CLINICAL EVALUATION FOLLOWS: HISTORY:THE RULE OF “ODP” SHOULD BE KEPT IN MIND THROUGH HISTORY SHOULD BE EXTRACTED FROM THE PATIENT THE PREVIOUS PHOTOGRAPH CAN HELP DISTINGUISH THE AGE OF PTOSIS AS THE PATIENT MAY BE GIVING IRRELEVANT HISTORY.
- 12. MARGIN-REFLEX DISTANCE: DISTANCE BETWEEN THE UPPER LID MARGIN AND THE CORNEAL REFLECTION OF A PEN TORCH HELD BY US AT WHICH THE PATIENT IS DIRECTLY LOOKING. NORMAL IS 4-4.5 MM
- 13. PALPEBERAL FISSURE HEIGHT: DIST BETWEEN THE UL AND LL MARGINS THE UL MARGIN 2MM BELOW THE UPPER LIMBUS AND THE LL MARGIN 1MM ABOVE THE LOWER LIMBUS IN MALES: 7-10 MM IN FEMALES: 8-12 MM CAN BE CLASSIFIED AS MILD MODERATE SEVERE
- 14. LEVATOR FUNCTION:PLACE A THUMB FIRMLY OVER PATIENTS BROW TO NEGATE THE ACTION OF FRONTALIS MUSCLE WITH THE EYES IN DOWNGAZE THEN THE PATIENT IS ASKED TO LOOK UP AS FAR AS POSSIBLE THEN THE EXCURSION IS MEASURED BY A RULER.
- 15. UPPER LID CREASE: IT IS VERTICAL DISTANCE BETWEEN THE LID MARGIN AND THE LID CREASE IN DOWNGAZE……… FEMALES:10 MM MALES: 8 MM
- 16. ASSOCIATED SIGNS: FATIGABILITY: ASK THE PAT. TO LOOK UP WITHOUT BLINKING FOR 30 SECONDS IF THE PATIENTS FAILS TO MAINTAIN THE UPWARD GAZE IS SUGGESTIVE OF M.G COGAN TWITCH SIGN: OVERSHOOT OF THE UL ON SACCADE FROM DOWNGAZE TO THE PRIMARY POSITION.
- 17. JAW WINKING PHENOMENON:CAN BE SEEN IF THE PATIENT IS PTOTIC AND WE ASK THE PATIENT TO CHEW OR OPEN HIS/HER MOUTH.
- 18. BELLS PHENOMENON: IT IS TESTED BY MANUALLY HOLDING THE LIDS OPEN,ASKING THE PATIENT TO TRY TO SHUT HIS EYES AND OBSERVING THE UPWARD AND OUTWARD ROTATION OF THE GLOBE
- 19. OTHER BATTERY OF TESTS
- 20. THIS TEST IS AN EASY OPD BASE PROCEDURE ASK THE PATIENT TO SIT COMFORTABLY ASK HIM/HER TO CLOSE THEIR EYES HOLD AN ICE PACK OVER THE CLOSED EYES WAIT FOR 5 MINUTES OBSERVE AFTER 5 MINUTES NOTE ANY IMPROVEMENTS
- 21. EDROPHONIUM(TENSILON)TEST: EDROPHONIUM CHLORIDE INHIBITS ACETYLCHOLINESTERASE IT RESULTS IN THE PROLONGED PRESENCE OF ACT A THE NMJ THIS RESULTS IN ENHANCED MUSCLE STRENGTH POSITIVE: ELEVATION OF EYELIDS IN 2-5MINS POST ADMINISTRATION OF TENSILON NEGATIVE: NO IMPROVEMENT EVEN 3 MINUTES DRAWBACK: THIS HAS A RELATIVELY LOW SENSITIVITY APPROX. 60% FOR MG S/E: DUE TO OVERACTIVATION OF THE PARASYMPATHETIC SYSTEM & CAUSE UNWANTED S/E FAINTING,DIZZINESS,INVOLUNTARY DEFECATION, SEVERE BRADYCARDIA,APNEA, AND THE MOST DREADED ONE CARDIAC ARREST. SAVIOR: ATROPINE AT HAND
- 22. OPTIONS ARE EVERYWHERE EYELIDS CRUTCHES A PROTOTYPE EXTERNAL MAGNETS