This document describes a case of congenital ptosis in a 20-year-old patient who had drooping of the left upper eyelid since birth. Examination found severe ptosis of over 4 mm in the left eyelid with an absent lid crease and poor levator function. The choice of operation for this patient was a frontalis sling operation to address the congenital ptosis. The document also provides details on assessing and classifying ptosis, pre-operative evaluation, and treatment options.

1. A CASE OF CONGENITAL PTOSIS
From department of Ophthalmology
and Plastic surgery
A case of Congenital ptosisA CASE OF CONGENITAL PTOSIS
Dr Samuel Ponraj
MS Ophthal [ 1 st year Pg]

2. • A 20 year old patient who complained of
drooping of the left upper eyelid since birth
There was no similar complaints in the family
O/E : -Severe ptosis > 4 mm of left upper eyelid
-Absent lid crease
-Bell’s phenomenon [ + ]
- Poor levator function of < 5 mm
- Normal frontalis action
Choice of operation : Frontalis sling operation

3. ABSENT LID CREASE
PTOSIS > 4 mm

4.  - Test for unilateral /bilateral severity of ptosis
 - Measurement of MRD 1 [margin reflex distance]
MLD [ margin limbus distance]
MCD [ margin crease distance ]
 - Upper lid excursion [Levator function]
 -Bell’s phenomenon
 - Marcus Gunn jaw-winking phenomenon
 - Rule out Pseudoptosis
PREOPERATIVE ASSESSMENT

5.  Evaluate for symptoms like Diplopia ,Dryness,
Photophobia, Irritation which may worsen after
surgery
 Pupillary size
 Extraocular motility
 Examination of orbit
 Tensilon test [myasthenia gravis]
 Corneal staining [for keratopathy]
 Dilated fundus examination
 Imaging studies

12. PRE-OPERATIVE

13. IMMEDIATE POST OPERATIVE

14. POST OPERATIVE

15.  CONGENITAL
I. Simple
II. Complicated
 ACQUIRED
I. Neurogenic
II. Myogenic
III. Aponeurotic
IV. Mechanical
CLASSIFICATION

16. Treatments of choice
• Fasanella – servat operation
• Levator resection - Blaskoviks & Everbusch
techniques
• Frontalis suspension

17. THANK YOU