eyes diseases, eyelid ,ocular diseases, ptosis examination, treatment of ptosis,

1. 3rd year bsc optometry
NETHRADHAMA SCHOOL OF OPTO

2. Introduction
 Abnormal drooping of the upper eyelid is called Ptosis.
 Normally, upper eyelid covers about upper one sixth of
cornea, i.e., about 2mm. Therefore in ptosis it covers more
than 2mm.

3. Examination
 Examination include
 Evaluation
 Measurement of amount(degree) of ptosis
 Margin reflex distance
 Assessment of levator function
 Special investigation
 Photographic record

4. Evaluation
 Pseudoptosis (simulated ptosis) should be excluded
on inspection.
 Points to be observed:
 Whether ptosis is unilateral or bilateral.
 Function of orbicularis oculi muscle.
 Eyelid crease is present or absent.
 Jaw-winking phenomenon is present or not.
 Associated weakness of any extraocular muscle.
 Bell’s phenomenon( up and outrolling of the eyeball during
forceful closure) is present or absent.

5. Measurement of amount (degree) of
ptosis
 In unilateral cases, difference between the vertical
height of the palpebral fissures of the two sides
indicates the degree of ptosis.
 In bilateral cases it can be determined by
measuring the amount of cornea covered by the
upper lid and then subtracting 2mm.
 Ptosis is graded depending upon
its amount as :
 Mild ptosis: 2mm
 Moderate ptosis: 3mm
 Severe ptosis: 4mm

6. Margin reflex distance
 Margin reflex distance (MRD) refers to the
distance between the upper lid margins and
corneal light reflex .
 Normal value of MRD is 4-5 mm.

7. Assessment of levator function
 It is measured by the 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 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 the examiner
 Levator function is graded as follows:
 Normal: 15mm
 Good: 8mm or more
 Fair: 5-7 mm
 Poor: 4mm or less

9. Special investigation
 Tensilon test is performed when myasthenia is suspected.
 Phenylephrine test is carried out in patients suspected of
Horner’s syndrome.
 Neurological investigations may be required to find out the
cause in patient with neurogenic ptosis.

10. Photographic records
 Photographic records of the patient should be
maintained for comparison.
 Photographs should be taken in primary position
as well as in up and down gazes.