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.

1. Blepharoptosis Dr. Anupama Karanth www.ophthalclass.blogspot.com

2. Drooping of upper eyelid Ptosis

3. Diagnosis of ptosis Drooping of upper eyelid Palpebral fissure is narrowed Upper eyelid covers more than the normal 2 mm of cornea Brow elevation due to frontalisoveraction Chin up head posture in bilateral ptosis

4. Does this patient have ptosis? Pseudoptosis - Phthisis bulbi ( left eye ) with cataract and iridocyclitis

5. Pseudoptosis Enophthalmos Microphthalmos Phthisis bulbi Contralateral eye Hypertropia Eyelid retraction

6. Types of ptosis

7. Congenital ptosis

8. Congenital ptosis

9. Visual function in congenital ptosis Amblyopia is present in 20% of patients with congenital ptosis

10. Marcus Gunn jaw winking ptosis

11. Acquired ptosis

12. Acquired ptosis

14. Thinning or disinsertion of levatoraponeurosis

16. Aponeuroticptosis

17. Congenital Myogenic Vs Acquired AponeuroticPtosis

18. Myogenicptosis

21. Chronic Progressive External Ophthalmoplegia (CPEO)

23. Involvement of other extraocular muscles

24. Pigmentary retinopathy

26. Christmas tree cataract

27. Myopathicfacies

29. Antibodies to acetylcholine receptors

30. Easy fatiguability

32. IV antiacetylcholinesterase drug, ptosis improves on injection

33. Other tests

34. Ice pack test - improves ptosis

35. Prolonged upgaze - worsens ptosis

37. III nerve paralysisHorner’s syndrome

39. Hypertension

40. Atherosclerosis

41. Sudden onset

42. Pupil sparing

44. Progressive symptoms

45. Pupil involved

48. Normal pupillary reactions

49. Enophthalmos

52. Traumatic ptosisfollowing orbital injury

53. Mechanical ptosischalazion

54. Mechanical ptosisplexiformneurofibroma

55. Management of Ptosis

57. Marginal reflex distance

58. Upper lid crease and fold

60. Surgical management Dependent on levator function