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ptosis ppt
1) Ptosis is an abnormally low position of the upper eyelid that can be congenital or acquired. Congenital ptosis is usually bilateral and hereditary, caused by defective development of the levator palpebrae superioris muscle. Acquired ptosis has several causes including neurogenic (e.g. third nerve palsy), myogenic (e.g. myasthenia gravis), aponeurotic, or mechanical factors like tumors. 2) Myasthenia gravis is tested for using edrophonium, which temporarily improves ptosis and diplopia. Marcus Gunn jaw-winking syndrome is a rare form of congenital ptosis where the eyel
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ptosis ppt
- 2. TYPES & CAUSESOF PTOSIS by Dr MAZHAR ALI
- 3. DEFINITION • Ptosis isan abnormally low position of the upper lid which may be congenital or acquired
- 4. Typess • Congenital 1. Simple 2.Complicated • Acquired 1. Neurogenic 2. Myogenic 3. Aponeurotic 4 Mechanical Pseudoptosis
- 5. Congenital Ptosis • Commonestform of ptosis • Usually bilateral / Heriditary • Due to defective development of LPS • Simple congenital ptosis is an isolated abnormality
- 6. Congenital Ptosis • Complicated– when associated with developmental abnormality of surrounding structures Associated Superior rectus palsy Abnormal synkineses – Marcus Gunn ptosis Dystrophy of the LPS Blepharophimosis syndrome (Ptosis, horizontal shortening of palp aperture, epicanthus inversus, telecanthus lat ectropion of the lower lids)
- 7. Simple congenital ptosis •Developmental dystrophy of levator muscle • Occasionally associated with weakness of superior rectus Unilateral or bilateral ptosis of varying severity In downgaze ptotic eyelid is slightly higher Frequent absence of upper lid crease Usually poor levator function
- 8. Marcus Gunn jaw-winkingsyndrome • Accounts for about 5% of all cases of congenital ptosis • Retraction or ‘wink’ of ptotic lid in conjunction with stimulation of ipsilateral pterygoid muscles Opening of mouth Contralateral movement of jaw
- 9. Acquired Ptosis • Usuallyunilateral Types 1.Neurogenic – Third nerve paralysis or due to reduced sympathetic innervation (Horner syndrome – ptosis, anhydrosis and miosis)
- 10. Left third nervepalsy Severe unilateral ptosis and defective adduction Normal abduction Defective elevation Defective depression
- 11. Horner syndrome • Causedby oculosympathetic palsy • Usually unilateral mild ptosis and miosis • Slight elevation of lower lid • Normal pupillary reactions • Iris hypochromia if congenital or longstanding • Anhydrosis if lesion is below superior cervical ganglion
- 12. Right third nervemisdirection • Rare, unilateral • Aberrant regeneration following acquired third nerve palsy • Pupil is occasionally involved • Bizarre movements of upper lid accompany eye movements Right ptosis in primary position Worse on right gaze Normal on left gaze
- 13. Acquired Ptosis 2. Myogenic– gradual onset, bilateral condition, symmetrical Myotonic dystrophy Chronic progressive exophthalmoplegia Mysthenia gravis ( damage to acetyl-cholin receptor at postsynaptic membrane with presence of antiacetylcholine receptor antibodies)
- 14. Acquired Ptosis Mysthenia Gravis- Symptoms– variable Signs – bilateral ptosis, increases by prolonged fixation or attempt to look up , external ophthalmoplegia – partial or complete Conformation by edrophonium injection test
- 15. Ocular myasthenia • Insidious,bilateral but asymmetrical • Worse with fatigue and in upgaze Ptosis • Intermittent and usually vertical Diplopia
- 16. Edrophonium test • Measureamount of ptosis or diplopia before injection • Inject i.v. atropine 0.3 mg • Inject i.v. test dose of edrophonium (0.2 ml-2 mg) • Inject remaining (0.8 ml-8 mg) if no hypersensitivity Before injection Positive result
- 17. Acquired Ptosis Aponeurotic Ptosis Isinvolutional is due to weakness or disinsertion of LPS aponeurosis from ant surface of tarsal plate High lid fold with good LPS function
- 18. Aponeurotic ptosis • Weaknessof levator aponeurosis • Causes - involutional, postoperative and blepharochalasis High upper lid crease Good levator function Absent upper lid crease Deep sulcus Mild Severe
- 19. Acquired Ptosis • MechanicalPtosis – • ptosis is caused by the gravitational effect of a mass or by scarring • Tumour or inflammation weight down the lid
- 20. Mechanical ptosis Causes Dermatochalasis Largetumours Severe lid oedema Anterior orbital lesions
- 21. Pseudoptosis • false impressionof ptosis may be caused by the following • 1 Lack of support of the lids by the globe may be due to an orbital volume deficit associated with an artificial eye • 2 Contralateral lid retraction, • 3 Ipsilateral hypotropia causes pseudoptosis because the upper lid follows the globe downwards • 4 Brow ptosis due to excessive skin on the brow, or 7th nerve palsy,
- 22. Causes of pseudoptosis Ipsilateralhypotropia Brow ptosis - excessive eyebrow skin Dermatochalasis - excessive eyelid skin Lack of lid support Contralateral lid retraction
- 23.