Blepharoptosis<br />Dr. Anupama Karanth<br />www.ophthalclass.blogspot.com<br />
Drooping  of  upper  eyelid<br />Ptosis<br />
Diagnosis of ptosis<br />Drooping of upper eyelid<br />Palpebral fissure is narrowed<br />Upper eyelid covers more than th...
Does this patient have ptosis?<br />Pseudoptosis - Phthisis bulbi ( left eye ) with cataract and iridocyclitis<br />
Pseudoptosis<br />Enophthalmos<br />Microphthalmos<br />Phthisis bulbi<br />Contralateral eye<br />Hypertropia<br />Eyelid...
Types  of  ptosis<br />
Congenital  ptosis<br />
Congenital ptosis<br />
Visual function in congenital ptosis<br />Amblyopia is present in 20% of patients with congenital ptosis<br />
Marcus Gunn jaw winking ptosis<br />
Acquired  ptosis<br />
Acquired ptosis<br />
Aponeuroticptosis<br />Most common acquired ptosis<br /><ul><li> Usually age related
Thinning or disinsertion of levatoraponeurosis
Disinsertion from tarsal plate causes retraction of aponeurosis</li></li></ul><li>Aponeuroticptosis<br />
Aponeuroticptosis<br />
Congenital Myogenic  Vs Acquired AponeuroticPtosis<br />
Myogenicptosis<br />
Myogenicptosis<br />At the level of the myoneural junction<br /><ul><li>Myasthenia gravis
Ocular myasthenia</li></ul>At the level of the muscle<br /><ul><li>Myotonic dystrophy
Chronic Progressive External Ophthalmoplegia (CPEO)
Oculopharyngeal dystrophy</li></li></ul><li>Muscular dystrophies<br />CPEO<br /><ul><li>Bilateral symmetrical progressive ...
Involvement of other extraocular muscles
Pigmentary retinopathy
Cardiac conduction abnormalities</li></ul>Myotonic dystrophy<br /><ul><li>Bilateral symmetrical progressive ptosis
Christmas tree cataract
Myopathicfacies
Cardiac conduction abnormalities</li></li></ul><li>Myasthenia gravis – Clinical features<br />Fluctuating ptosis is the ch...
Antibodies to acetylcholine  receptors
Easy fatiguability
Life threatening symptoms – dysphagia, dyspnoea</li></li></ul><li>Myasthenia gravis – diagnosis and treatment<br />Treatme...
IV antiacetylcholinesterase drug, ptosis improves on injection
 Other tests
Ice pack test - improves 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 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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Lids and Adnexa Class3 - Ptosis

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

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