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

Acquired

NeurogenicPartial or

complete 3rd nerve palsy

Horner’s syndrome

MyogenicMyasthenia

gravisOcular

myopathySenile

MechanicalExcess weight due to edema, tumors, large

chalazionConjunctival

scarring

TraumaticTrauma to the levator muscleIatrogenic eg: post-surgical

(eg: after cataract surgery

Pseudoptosis

• Due to surgical anophthalmus, microphthalmus, and phthisis bulbi

• Due to hypotropia• Due to dermatochalasis

History

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• Bell’s 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)