This document provides an overview of ptosis, or drooping of the upper eyelid. It defines ptosis and classifies it as either congenital or acquired, with mechanisms including neurogenic, myogenic, aponeurotic, or mechanical causes. It describes measurements used in diagnosis such as margin-reflex distance, palpebral fissure height, levator function, upper eyelid crease, and lagophthalmos. Common types of ptosis like congenital, Marcus Gunn jaw-winking syndrome, and involutional are explained. Differential diagnosis and management options including non-surgical and surgical treatments like eyelid crutches, levator advancement, resection, and frontalis suspension are summarized
6. Measurements
Palpebral fissure height
•Distance between upper and lower lid margin
•Normal:
– Women: 8-12 mm
– Men: 7-10 mm
•Upper lid: 2mm below sup. limbus
•Lower lid: 1mm above inf. Limbus
7. Measurements
Levator function
•Place thumb against brow to stop frontalis
•Patient look down
•Then look up
•Measure with a ruler
•Results:
– >15mm: normal
– 12-14 mm: good
– 5-11 mm: fair
– <4 mm: poor
8. Measurements
Upper eye lid crease
•Veritcal margin of lid crease and lid margin in downgaze
•Normal:
– Women: 10 mm
– Men: 8 mm
12. Neurogenic Ptosis
Acquired ptosis
•CN III palsy
– Ischemic or compressive
– Pupil or non-pupil involved
•MG
– Ptosis worsens with fatigue
– Eye fatigability test
– Ice pack test
– Acetylcholine receptor AB test
13. Myogenic Ptosis
Congenital ptosis
•Malformation of levator muscle
•Fibrous and adipose tissue replace muscle
•Signs:
– Decrease levator function
– Eye lid lag
– Lagophthalmos
– Upper lid crease absent or poorly formed
– Downgaze ptotic eye lid higher than fellow eye
16. Aponeurotic Ptosis
• Involutional attenuation
• Repetitive traction (rubbing, contact lenses, surgery)
• Signs:
• High or absent upper lid crease
• Thinning of eye lid
• Good levator function
• Worsen in downgaze
23. Frontalis muscle suspension
• Indications:
• Severe ptosis (>4mm) poor levator function (<4mm)
• Marcus Gunn
• Blepharophimosis
• CN III palsy
• Unsatisfactory result from previous levator resection
24. Frontalis muscle suspension
A. Site of incision marked
B. Threading of fascia lata strip
C. Tightening and tying of strip