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Ptosis
- 2. ORBIT, EYELIDS AND LACRIMAL SYSTEM-AAO 2015-16 YANOFF,DUKER OPHTHALMOLOGY FOURTH EDITION KANSKI CLINICAL OPHTHALMOLOGY EIGHT EDITION ALBERT AND JAKOBIEC’S PRINCIPLES AND PRACTICE OF OPHTHALMOLOGY THIRD EDITION
- 3. INRODUCTION HISTORY CLASSIFICATION DIFFERENCES EXAMINATION SURGERY
- 4. BLEPHAROPTOSIS: Inferior displacement of upper eyelid
- 5. 1857- Bowman described shortening of levator muller muscle complex through a conjunctival incision 1883- Everbusch and Snellen reported anterior levator resection 1897-Motais and Perinaud described superior rectus suspension 1975- Jones published the successful repair of acquired ptosis by levator aponeurotic reattachment or resection.
- 7. 1.MYOGENIC •SIMPLE • BLEPHAROPHIMOSIS •DOUBLE ELEVATOR PALSY •COFS •CPEO •OCULOPHARYNGEAL DYSTROPHY •MUSCULAR DYSTROPHY 2. NEUROGENIC •3RD NERVE PALSY •HORNER’S SYNDROME •MYASTHENIA GRAVIS •MARCUS GUNN JAW WINKING 3.APONEUROTIC •INVOLUTIONAL •POST TRAUMATIC •BLEPHAROCHALAIS •RECURRENT EDEMA
- 8. MECHANICAL •DERMATOCHALASIS •EYELID MASS •ORBITAL MASS •SCARRING PSEUDOPTOSIS •GLOBE MALPOSITION •HYPOTROPIA •CONTRALATERAL EYELID RETRACTION
- 9. 1.MYOGENIC • SIMPLE •BLEPHAROPHIMOSIS •DOUBLE ELEVATOR PALSY •COFS •CPEP •OCULOPHARYNGEAL DYSTROPHY •MUSCULAR DYSTROPHY
- 10. •Dysgenesis of levator muscle • Histopath- decreased / absent striated muscle Presence of fibrous/adipose tissue • Associations: SIMPLE CONGENITAL PTOSIS
- 11. Poor eyelid movement Paucity of muscle fibres Decreased/ no functioning of LPS Lid lag
- 12. (A) Decreased levator muscle function occurs along with an indistinct upper eyelid crease. (B) The ptosis is exaggerated in upgaze due to the poor function of the levator muscle. (C) In downgaze, the ptosis is reduced or absent because the fibrotic levator muscle cannot stretch. a) b) c)
- 13. BLEPHAROPHIMOSIS SYNDROME •TELECANTHUS+EPICANTHUS + POORLY DEVELOPED NASAL BRIDGE+PTOSIS+HORIZONTAL SHORTENING OF PALPEBRAL FISSURE •Sx for epicanthus- •Sx for ptosis-(levator function poor)
- 14. DOUBLE ELEVATOR PALSY Ptosis+ inability to supraduct ipsilateral eye Levator function-poor
- 15. Introduction: Ptosis + ophthalmoplegia Clinical features: Gene Types: TYP E PTOSIS GLOBE INHERITA NCE GENE COMME NTS 1 B/L INFRADUC TION AD 12p11. 2-q12 CHIN UP 2 B/L EXOTROPIA AR 11q IRANIAN /MID EAST 3 VARIABL E VARIABLE AD 16q24. 2-24.3 VERTICA L LIMITAT ION 4 U/L VARIABLE SPORADI C -
- 17. 2. NEUROGENIC •3RD NERVE PALSY •HORNER’S SYNDROME •MYASTHENIA GRAVIS •MARCUS GUNN JAW WINKING
- 19. BEFORE AFTER
- 20. CONGENITAL AQUIRED COMPONENTS
- 24. Most common form of ptosis Stretching or dehiscence of the levator aponeurosis.
- 25. Upper lid crease
- 26. BLEPHAROCHALASIS
- 28. DERMATOCHALASIS
- 29. PTOSIS DUE TO EYELID MASS
- 34. BROW PTOSIS CORRECTION:Browpexy, direct brow lift,endoscopic or pretrichial brow lift
- 36. CONGENITAL MYOGENIC PTOSIS ACQUIRED APONEUROTIC PTOSIS Mild to severe ptosis Poorly formed Reduced Lid lag Mild to severe ptosis Higher than normal or absent Near normal Eyelid drop 1.MRD 1 2.Upper eyelid crease 3. Levator function 4. Downgaze
- 37. 1. HISTORY Age of onset Progression Family history Marked variability in degree of ptosis during day Diplopia Presence of dysphonia, dypnoea,dysphagia or proximal muscle weakness
- 38. 1. MARGIN REFLEX HEIGHT(MRD1, MRD2) 2. PALPEBRAL FISSURE HEIGHT 3. UPPER EYELID CREASE 4. LEVATOR FUNCTION 5. LAGOPHTHALMOS
- 39. 1. Head position, chin elevation,brow position and brow action- 2. Quantity and quality of tear film 3. Bell’s phenomenon 4. Corneal sensation 5. Synkinesis 6. Herring’ law 7. Position of ptotic eyelid in downgaze
- 40. 7. Visual acuity 8. Extraocular muscle function 9. Pupillary examination 10. External examination
- 41. 1. Visual field testing(untaped and taped) 2. Photography 3. Pharmacological testing
- 42. EYELID EXCURSION LEVATOR FUNCTION DEGREE OF PTOSIS SURGERY 0mm Absent Severe Frontalis suspension 1-4mm Poor Severe Frontalis suspension or maximal ext levator resection+tarsal resection 5-7mm Fair Moderate Ext levator resection 8-10mm Good Mild Ext levator resection 11mm Excellent Mild Internal conjunctival muller’s muscle resection
- 51. Overcorrection Eyelid Crease Abnormalities Lagophthalmos and Exposure Keratitis Changes in Astigmatism
- 52. THANK YOU