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AECS Illumination
AECS Illumination
Non-surgical Treatment1
1. Lid crutches may be used to support a drooping
lid mechanically. The type used is a wire
support in the form of a semi lunar soldered
to the upper part of the rims of a pair of
spectacles.
2. Haptic contact lens with a shelf on which the
margin of upper lid rests may be used.
3. Elevation of the lid by a mechanic force: a strip
of highly magnetically metal is implanted in
the upper lid and a magnet is placed behind
the upper rim of the frame.
Surgical treatment however, is required in
most cases of ptosis to obtain a satisfactory result
from cosmetic and functional points of view. Over
100 modifications of techniques are to be found
in literature all of which can be resolved into a few
general procedures.
When to correct ptosis surgically6
Correction of ptosis in a child can often be delayed
until the patient is several years old, although
consistent chin up positionings / complete
ptosis may justify early surgery6. In general,
congenital ptosis should be repaired when accurate
measurements are obtainable and before the child
begins school. Most children can undergo repair
around 4-5 years of age. Severe ptosis, which may
cause amblyopia, must be surgically repaired as
soon as possible to preserve normal vision.
Note : An acquired ptosis from a traumatic
injury or a third nerve palsy should not be operated
on before 6 months of age, because often some
levator function will return. Any other acquired
ptosis may be repaired when the cause has been
determined. Specially myasthenia gravis must be
ruled out.
Indications for surgery in congenital
ptosis
In most instances the primary reason for correcting
congenital ptosis is cosmetic. In case of unilateral
congenital ptosis of such severity that normal
visual development is compromised by total
AECS Illumination
Degree of Ptosis
Levator Function
Amount of levator
resection
Ideal preoperative
correction
Under correct by
1 - 3mm
3 mm (moderate)
Large (18-22)
Maximal (23 or more)
4 or more (severe)
Super maximal
(27 or more)
Frontalis sling
References
1. System of ophthalmology edited by Sur Stewart Duke Elder. Congenital deformities Vol.3 part. 2
2. Clinical ophthalmology. Jack J. Kanski. Fifth Edition. Butterworth Heinemann publishers. P 32-39.
3. Allen M Puttrman. Basic oculoplastic surgery in Vol.3. Chap 33 P.2251. Edited by Peyman GA, Sanders
DR, Goldberg MF. Ist Indian eition. Jaypee brothers.
4. Putterman Am: Basic oculoplastic surgery. In Peyman GA, Sanders DR, Goldberg MF (eds). Principles of
practice of ophthalmology. P2248-2250 philadelphia, WB saunders, 1980.
5. Putterman Am: Evaluation of the cosmetic oculoplastic surgery 2nd Ed. P12-26. Philadelphia, WB
saunders, 1993.
6. Paediatric Ophthalmology and Strabismus Sec.6. 2001-2002. P-172.