This document provides an overview of eyelid anatomy and ptosis. It describes the gross anatomy, layers, muscles, glands, blood supply, nerves and functions of the eyelid. It then discusses ptosis in detail including types (congenital, acquired), evaluation methods and treatment options depending on levator function and ptosis severity. Surgical procedures for ptosis include levator resection, frontalis sling, tarsoconjunctival resection. Common eyelid conditions like blepharitis, stye, chalazion are also briefly mentioned.
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
Each eyelid contains a fibrous plate, called a tarsus, that gives it structure and shape; muscles, which move the eyelids; and meibomian (or tarsal) glands, which secrete lubricating fluids. The lids are covered with skin, lined with mucous membrane, and bordered with a fringe of hairs, the eyelashes.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Class 1 in the series deals with the basic anatomy of the eyelid and the eyelid margin. A few of the congenital eyelid disorders are mentioned. Special emphasis is given to blepharitis – inflammation of the eyelid margin, its types, clinical features and management. Next, common causes of eyelid swellings including hordeolum or stye and chalazion are discussed. Finally a brief mention is made about disorders of the eyelashes – trichiasis, poliosis, madarosis and distichiasis.
A surgical procedure featuring a partial thickness scleral flap that creates a fistula between AC and subconjunctival space for filtration of aqueous and creation of conjunctival bleb in an effort to lower IOP
www.ophthalclass.blogspot.com has the complete class and MCQs on lids and adnexa for undergraduate medical students. Class 1 in the series deals with the basic anatomy of the eyelid and the eyelid margin. A few of the congenital eyelid disorders are mentioned. Special emphasis is given to blepharitis – inflammation of the eyelid margin, its types, clinical features and management. Next, common causes of eyelid swellings including hordeolum or stye and chalazion are discussed. Finally a brief mention is made about disorders of the eyelashes – trichiasis, poliosis, madarosis and distichiasis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Gross Anatomy
Mobile Tissue curtain placed in front of eyeball
FUNCTION
Act as shutter- protects
the eye from injuries
and excessive light.
Perform an important
function of spreading
the tear film on the
cornea and conjunctiva.
Help in Drainage of
tears by Lacrimal Pump
Action,
3. Eyelid has two parts
• Orbital
• Tarsal
• Divided by Horizontal Palpebral
Furrow/sulcus
• Upper lid covers about 1/6th of
the cornea (2mm)
• Lower Lid just touches the
limbus
• Palpebral Fissure -Eliptical space
between upper and lower lid
• Verical extent – 10-11mm
• Horizontal extent – 28-30mm
• Lids meet at Medial and lateral
canthi
• Lateral canthi 2mm higher than
medial canthi.(Mongoloid Slant)
10-11mm
28-30mm
4. LID MARGIN- 2mm broad, divided
into two parts by punctum
Medial- LACRIMAL PORTION-
Rounded Devoid
of EyelashesLateral- CILIARY PORTION
Anterior Border -
Rounded
Posterior Border –
Sharp
INTERMARGINAL
STRIP- Between 2
borders Grey line – marks
junction of skin and
conjunctiva
Divides intermarginal strip into –
Anterior strip bearing 2-3 layers of
Eyelashes
Posterior strip-Meibomian
glands arranged in a row.
Splitting of Eyelids in
surgeries done at the grey
line.
5. STRUCTURE OF EYELID
SKIN:
Elastic, fine
texture, thinnest
in the body
Subcutaneous
tissue:
Very Loose,
contains no fat.
Readily
distended by
blood or oedema
Layer of striated muscle:
Orbicularis muscle-Forms an oval sheet
around eyelids
• Orbital, Palpebral and Lacrimal parts.
• Closes the Eyelids, supplied by
Zygomatic branch of the Facial Nerve.
In paralysis of Facial Nerve there occurs
Lagophthalmos which may be
complicated by exposure Keratitis.
6. Levator palpebrae superioris
muscle (LPS)
It arises from the apex
of the orbit and is
inserted by three parts
on the
skin of lid,
anterior surface of
the tarsal plate
conjunctiva of
superior fornix.
It raises the upper lid. It is supplied
by a branch of oculomotor nerve. Submuscular areolar
tissue.
• It is a layer of loose connective
tissue.
• The nerves and vessels lie in this
layer.
• Therefore, to anaesthetise lids,
injection is given in this plane.
7. Fibrous layer. It is the framework of the lids
and consists of two parts:
Tarsal plate. dense
connective tissue, one for
each lid,
• shape and firmness to the lids.
• The upper and lower tarsal plates
meet at medial and lateral canthi;
attached to the orbital margins
through medial and lateral
palpebral ligaments.
• In the substance of the tarsal plates
lie Meibomian glands in parallel
rows.
Septum orbitale (palpebral
fascia)
• thin membrane of connective
tissue attached centrally to the
tarsal plates and peripherally to
periosteum of the orbital margin.
• It is perforated by nerves, vessels
and levator palpebrae superioris
(LPS) muscle, which enter the lids
from the orbit.
8. Layer of non-striated muscle fibres.
consists of the palpebral muscle of Muller
which lies deep to the septum orbitale in
both the lids.
• In the upper lid it arises from the
fibres of LPS muscle and
• lower lid from prolongation of the
inferior rectus muscle; and is
inserted on the peripheral margins
of the tarsal plate.
• It is supplied by sympathetic
fibres.
9. • Meibomian glands (tarsal glands)
• present in the stroma of tarsal plate arranged
vertically.
• 30–40 in the upper lid ,20–30 in the lower lid.
• modified sebaceous glands. Ducts open at the
lid margin.
• secretion constitutes the oily layer of tear film.
• Glands of Moll.
• modified sweat glands situated near
the hair follicle.
• open into the hair follicles or the
ducts of Zeiss glands.
• Secrete sebum.
• Accessory lacrimal glands of
Wolfring.
• These are present near
the upper border of the
tarsal plate
• Glands of Zeis.
• These are also
sebaceous glands
which open into the
follicles of eyelashes.
Conjunctiva. The part which lines the lids is called palpebral
conjunctiva. It consists of three parts: marginal, tarsal and orbital.
10. Blood Supply
Arteries of Lids: 2 arcades –
• Marginal arterial arcades- Medial and lateral palpebral
arteries arise from it
• Location- sub muscular plane in front of the Tarsal Plate
• Upper lid- 2mm away from the Lid margin
• Lower lid- 4mm away from the lid margin
• Superior Arterial Arcade
• Location- in the Upper lid, near the upper border of the tarsal
plate.
Veins- Arranged in 2 plexuses
• Post-Tarsal – Draining into Ophthalmic vein,
• Pre-tarsal – Draining into Subcutaneous Veins.
Lymphatics- Arranged into Pretarsal, post tarsal
• Median half of lids : drain into Pre-auricular Lymph Nodes
• lateral Half : Drain into Submandibular Lymph nodes.
12. PTOSIS
• Abnormal drooping of eyelids.
• The Upper eyelid covers more than 2 mm of cornea
Congenital Ptosis
Blepharophymosis
Syndrome
Marcus Gunn jaw-
winking syndrome
Acquired
Neurogenic
Third nerve palsy
Horner syndrome
Myogenic
Myasthenia gravis
Myotonic
dystrophy
Ocular myopathies
Aponeurotic Mechanical
13. Clinical Evaluation
• History -
• age of onset,
• family history,
• history of trauma,
• eye surgery
• variability in degree of
the ptosis.
Pseudoptosis- Rule out
• Ipsilateral conditions
• microphthalmos,
• phthisis bulbi,
• enophthalmos,
• prosthesis,
• brow ptosis,
• Dermatochalasis
• hypotropia.
• Contralateral conditions :
• eyelid retraction,
• high myopia
• proptosis
Examination
14. • Unilateral/Bilateral
• Function of orbicularis oculi muscle.
• Eyelid crease .
• 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.
16. Margin Reflex Distance
• Distance between upper
lid margin and light
reflex (MRD1, 4-
4.5mm)
• Mild ptosis MRD
1(2-2.5mm)
• Moderate ptosis
(MRD1 1-1.5mm)
• Severe ptosis (MRD1
<1mm) MRD 2-Normal value is 5- 5.5mm
17. Levator Function- Upper Lid Excursion
• Reflects levator function
• Normal (15 mm or more)
• Good (12 mm or more)
• Fair (5-11 mm)
• Poor (4 mm or less)
Important to apply
pressure on the
Eyebrow to block the
action of frontalis
muscle
18. Special Investigations.
• Phenylephrine test and cocaine 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.
19. TYPES OF PTOSIS
CONGENITAL PTOSIS
ETIOLOGY : Associated with congenital
weakness of Levator Palpabrae Superioris.
Features:
• Drooping of one/both eyelids since birth.(mild/moderate or
severe)
• Lid Crease- Diminished/Absent.
• Lid Lag on Downgaze( i.e. Ptotic Lid is higher than the
Normal),due to tethering effect of LPS, in contrast to
acquired where ptotic lid is lower in downgaze also.
• LPS function may be poor, fair or good depending upon
degree of weakness.
20. Associations
Blepharophymosis Syndrome
• Congenital Ptosis with Poor levator function
• Blepharophymisis
• Telecanthus(lateral displacement of medial
canthus)
• Epicanthus Inversus (lower lid fold larger than
upper)
Marcus Gunn Jaw Winking Ptosis
• Retraction of Ptotic lid with Jaw Movements.
• With stimulation of ipsilateral Pterygoid muscle
• Caused by abberent innervation
21. ACQUIRED PTOSIS
PTOSIS
MIOSIS
ANHYDROSIS
Rare entity, occurs due to interruption in
the sympathetic innervation to the eye.
Pre-Ganglionic
Post-Ganglionic
Central
•Cocaine Test
•Hydroamphetamine test
Conjunctivomullerectomy
23. MYSTHENIA GRAVIS
• Ptosis and diplopia
• Levator function-decreased
• Eyelid twitches-falls on prolonged gaze
• CAUSE-AUTOIMMUNE,ANTIBODIES TO
ach RECEPTORS
• Treatment-Medical,
Thymectomy(selected Patients)
24. Before injection Positive result
Edrophonium/
anticholinesterases prevents
breakdown of neurotransmitter
Acetylcholine
25. Chronic Progressive
External
Ophthalmoplegia
• Progressive Bilateral
mitochondrial
myopathy affecting
Extra ocular muscles.
• Gradually increasing
ptosis with lost
ocular motility
• Associated with
pigmentary
retinopathy and
heart block
• Treatment- Frontalis
Sling
Oculopharyngeal
Dystrophy
• Autosomal dominant
• Bilateral progressive
ptosis with facial
weakness.
Myotonic Dystrophy
• Characterised by
failure to relax
muscles after
sustained
contraction
• Associated with
Christmas Tree
cataract, frontal
balding, testicular
atrophy
MYOGENIC PTOSIS
26.
27. APONEUROTIC PTOSIS
• Develops due to defects of Levator
aponeurosis.
• Involution Ptosis(senile)
• Aponeurotic Weakness(Blepharochalasis)
• Traumatic Dehiscence/Disinsertion.
• Levator Function- Good.
• Rx Levator Resection
28. Mechanical Ptosis:
• It results from impaired mobility
of upper lid.
• Causes include dermatochalasis,
large tumours such as
neurofibromas, heavy scar tissue,
severe oedema and anterior orbital
leisions.
30. MILD PTOSIS + GOOD LF
+ Phenylephrine Test - Phenylephrine Test
Fasanella-Servat operation. Levator Advancement
with Resection
POOR LF -<5mm – FRONTALIS SLING
LF> 5MM – LEVATOR RESECTION
LF> 6mm – LEVATOR Advancement/
Fasanella Servat
31. Congenital Ptosis
Tarso-conjunctivo-Mullerectomy (Fasanella-
Servat operation).
• mild ptosis (1.5–2 mm) and good levator function.
• upper everted,and the upper tarsal border along
with its attached Muller’s muscle and conjunctiva
are resected.
• Almost always needs
surgical correction.
• SEVERE PTOSIS surgery
performed - earliest to
prevent stimulus
deprivation amblyopia
• MILD AND MODERATE
PTOSIS, surgery delayed
until the age of 3-4
years, when accurate
measurements are
possible.
32. Levator Resection
■Moderate ptosis.
•Depending on the level of LPS function the amount of LPS to be resected is as below:
•Good function : 16–17 mm (minimal)
•Fair function : 18–22 mm (moderate)
•Poor function : 23–24 mm (maximum)
■Severe ptosis.
•Fair levator function: 23–24
mm (maximum LPS
resection).
Conjunctival approach (Blaskowics’ operation):Skin approach (Everbusch’s operation):
33. Frontalis sling operation (Brow suspension).
• severe ptosis, no levator function.
• In this operation, lid is anchored to the frontalis muscle via a
sling. Fascia lata (best material) or some non-absorbable
material (e.g., supramide suture, silicon rod) may be used as
sling.
34. Treatment of acquired ptosis
• Treat the underlying cause wherever possible.
• Conservative treatment should be carried out and surgery deferred
at least for 6 months in neurogenic ptosis.
• Surgical procedures (when required) for acquired ptosis are
essentially the same as described for congenital ptosis. However, the
amount of levator resection required is always less than the
congenital ptosis of the same degree. Further, in most cases the
simple Fasanella-Servat procedure is adequate.
The upper lid crease or sup palpabral sulcus is due to the lecator palpabrae muuscle which entes the eye lids, making it tarsal part distinct. Inf palpabral sulcus is due to fibrous bands ariisng from inferior rectus muscle which insert into the lower lid. Naso jugal and malar sulcus marks juntion of denser tissue of cheeks.
2-3 layers of eye lashes , 100-150 rows upper eye lid,50-70 rows lower eyelid. lash direction- forward upward bakward upper, forward downwards and backwards lower. Anterior strip also consistd of glands of ziess asnd moll opens into the piliary canal. Lash Follicle surrounded by veins and nerves hence have exquisite tactile sensitivity.
Skin thin, variable no.of melanocytes, which may increase pigment production in response to chronic oedema/ inflammation.
Flat ribbon like muscle, (fleshy)passes through the orbital septum , and at the upper border of tarsus, devides into 3 parts,(tendinous part)
SUBMUSCULAR AREOLAR TISSUE- UPPER lid the levator p s divides spaces into preseptal and pre tarsal space.
These glands open into hair follicle and not into skin
MRD 1 + MRD 2 IS PALPEBRAL FISSURE HEIGHT. NO SOMETIMES THE PF CAN BE NORMAL AROUND 9, WITH MRD 1 AROUND 1-2 AND MRD 2 8 MM, SO THIS IS A CASE OF PTOSIS AND LOWER LID RETRACTION.
Blepharophymosis – narrow horizontal palpebral fissure. Normal 25-30. usually 20-22 in blepharophymosis. Medial and lateral canthoplasty for blepharophymosis followed by frontalis sling
Obliteration of levator function and frontalis sling is procedure of choice for marcus gun jaw winking.