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Ptosis

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

Myasthenia gravis Ocular myopathy Senile

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

Any contributing factor

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)

Brow (frontalis) suspension


In bilat cases where levator action is poor Tarsus is fixed to the frontalis musc via a sling of fascia lata or non absorbable materials

Aponeurosis strengthening
Useful for acquired ptosis with good levator f(x)