Ptosis
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Ptosis refers to abnormal drooping of the upper eyelid. There are two main types - congenital ptosis present from birth due to weakness of the levator palpebrae superioris muscle, and acquired ptosis caused by various factors like trauma, surgery, or neurological issues. Evaluation of ptosis involves measuring the amount of drooping, assessing levator function, and ruling out pseudoptosis. Treatment depends on severity and includes ptosis spectacles, tarso-conjunctival resection for mild cases, levator resection for moderate to severe congenital ptosis, or frontalis sling operation using various materials to suspend the eyelid in severe ptosis with no levator function.
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1. Ptosis, or drooping of the upper eyelid, can be congenital or acquired through various mechanisms including myogenic, neurogenic, mechanical, or aponeurotic causes.
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Ptosis
- 2. Ptosis • Abnormal drooping of the upper eyelid. • Types:- • Congenital. • Acquired.
- 3. Congenital Ptosis • Congenital weakness of the Levator Palpebrae Superioris muscle.
- 5. Features & Types • Drooping of eyelids • Lid crease-diminished or absent • Lid lag on downgaze • LPS function-poor,fair or good. • Simple Congenital Ptosis • Congenial ptosis with associated weakness of SR muscle • Blepharophimosis syndrome • Congenital synkinetic ptosis
- 6. Acquired Ptosis • Depending upon the cause,it can be • -Neurogenic • -Myogenic • -Aponeurotic • -Mechanical
- 8. Clinical Evaluation • History • Examination • Measurement of amount of ptosis • Margin reflex test • Assessment of Elevator function • Special Investigations • Photographic record
- 9. History • Age of onset • Family history • History of trauma • Eye surgery • Variability in degree of Ptosiz
- 10. Examination • Exclude Pseudoptosis • Measure amount of ptosis • Margin reflex distance • Assess Levator function • Photographic record
- 11. Exclude Pseudoptosis • Microphthalmos • Phthisis bulbi • Enophthalmos • High Myopia • Hypotropia
- 12. Observe • Unilateral or Bilateral ptosis • Function of orbicularis ocular muscle • Eyelid crease is present or absent • Jaw winking phenomenon • Associated weakness of extraocular muscles • Bell's phenomenon
- 13. Measurement of Ptosis • Unilateral- vertical height diff. of palpebral fissures • Bilateral- amount of cornea covered and subtracting 2 mm.
- 14. Margin Reflex Distance • Distance between upper lid margins and corneal light reflex • Notmal- 4-5 mm
- 15. Assessment of Levator Function
- 17. Special Investigations • Tensilon test • Phenylephrine test • Neurological investigations
- 19. Treatments • Ptosis spectacles • Surgery
- 22. Surgical Treatments • Surgeries for Congenital Ptosis • Surgeries for Acquired Ptosis
- 24. Done in mild ptosis • Upper lid everted • Upper tarsal border with Muller's muscle and conjunctiva are resected
- 26. For moderate and severe ptosis • Conjunctival approach • Skin approach
- 28. Severe ptosis • With no levator function • Lid is anchored to frontalis muscle • Via string • Fascia Lata • Supramide suture • Silicon rod
- 29. Thank You