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Definition Drooping of the upper eyelid, which may be: Unilateral or bilateral Partial or complete
Congenital ptosis
Due to imperfect differentiation of the levator palpebrae muscles Often associated with weakness of underlying sup. Rectus m. Often hereditary
Neurogenic
Partial or complete 3rd nerve palsy
Horners syndrome
Traumatic
Trauma to the levator muscle Iatrogenic eg: postsurgical (eg: after cataract surgery
Myogenic
Acquired
Mechanical
Excess weight due to edema, tumors, large chalazion
Conjunctival scarring
Pseudoptosis
Due to surgical anophthalmus, microphthalmus, and phthisis bulbi Due to hypotropia Due to dermatochalasis
Age of onset
Family history
History
Symptoms of systemic problems Presence of diplopia
Variability of ptosis
Examination
Amount of ptosis :
Mild = 2 mm Moderate = 3 mm Severe = 4 mm or more
Assessment of levator function Ocular motility testing Jaw-winking phenomenon Bells phenomenon Corneal sensitivity in neurogenic ptosis Photograph = as pre-operative record Tensilon test = to exclude myasthenia gravis Neurological evaluation
Treatment
Fasanella-servat operation
Simple tarso-conjunctival resection Useful in mild ptosis with good levator f(x)
Levator resection
Useful in congenital unilateral ptosis with fair to good levator f(x) Via skin approach (everbuschs) or conjunctival approach (Blaskowics)
Aponeurosis strengthening
Useful for acquired ptosis with good levator f(x)