8
Ptosis
Clinical
Definition
It signifies a drooping of the upper eye
lid, which may be unilateral or bilateral,
and partial or complete. Ptosis occurs due
to dysfunction of the muscles that raise
the eyelid or their nerve supply. It is more
common in the elderly, as muscles in the
eyelids may begin to deteriorate.
Aetiology
Ptosis is of mainly two types:
A. Congenital Ptosis: This mainly occurs
due to imperfect differentiation of the
levator muscle. It is often associated with
weakness of underlying superior rectus
muscle.
B. Acquired Ptosis : In most cases, an
acquired drooping of the upper eyelid
results from the ageing of the eyelid.
Usually the tendon that attaches the
‘lifting’ muscle to the eyelid stretches
Before Surgery
After Surgery
A R A V I N D
E Y E
C A R E
S Y S T E M
and the eyelid droops low. Occasionally
the condition results from other general
conditions such as Myasthenia Gravis
(MG), chronic progressive external
ophthalmoplegia (CPEO), IIIrd nerve
palsy, myasthenia gravis, ocular
myopathy, trauma etc.
Clinical evaluation of ptosis:
Patient history is taken considering the age of
onset of the disease, family history,presence of
diplopia,systemic problems and so on.
Examination is done by calculating the
amount of ptosis by noting the ptosis lid
margin with respect to the limbus and pupil.
Mild ptosis Moderate ptosis Severe ptosis
– 2 mm
– 3 mm
- 4 mm or more
Assessment of levator function:
1. The brow is immobilized by pressure
with the thumb (to negate the action of
frontalis)
2. Patient is asked to look down and then to
look up
3. Amount of excursion of the upper lid
margin is then measured with a ruler
(2 mm of movement is contributed by the
superior rectus muscle).
Normal - 15 mm
Good
- 8 mm or more
Fair
- 5 to 7 mm
Poor
- 4 mm or less
9
Treatment
Brow (Frontalis) suspension
1.
2.
3.
4.
This is applicable in bilateral cases where the
levator action is poor. Here, the tarsus is fixed
to the frontalis muscle, via a sling of fascia late
or non – absorbable materials.
Fasanella – serral operation
Levator resection
Brow (Frontalis) suspension
Aponeurosis strengthening
Fasanella – Serrat operation
It is the simple tarso – conjunctival resection
and is useful in mild ptosis with good levator
function (eg. Horner’s syndrome).
Levator resection
Useful in congenital unilateral ptosis with fair
to good levator function. It may be via:
a. Skin approach (Everbusch’s) : Especially
where larger resection in necessary
b. Conjunctival approach (Blaskowics):
Particularly useful for moderate resection
of LPS.
Aponeurosis strengthening
This is useful in acquired ptosis with good
levator function and is performed either by
advancement or by tucking. Advancement
may be combined with levator resection in
severe ptosis.
Timing of surgery in congenital ptosis
Severe Ptosis : Early intervention is necessary
due to danger of stimulus deprivation
amblyopia.
Mild to Moderate Ptosis: Surgical
correction is done between 3 – 4 years of age,
when accurate measurement can be obtained.
- Ms. M.R. Nagarani
Refraction, Aravind - Theni
Breast Feeding reduces the risk of ROP
An international team of doctors have proved breast fed babies drop the risk of retinopathy
of prematurity (ROP) from 75% to 90%.
Researchers from China, Canada and the UK reanalyzed the studies, done with more
than 2000 infants. The new analysis showed the reducing of the risk of ROP and it was
published on Nov-16 in the medical journal “Paediatrics”.
Studies in U.S. show, that 59% of babies born at 22 to 28 weeks have the ROP disorder.
In China 50% of the babies weigh less than one kilogram.
Breast feeding helps to prevent two conditions known as sepsis and necrotizing
entercolitis which require oxygen therapy. These two conditions are linked with the higher
risk of ROP. Mother’s own breast milk serves better than the donor’s milk, in this case, says
Dr.Adolf Llanos, a neonatologist of Miami.
Source: www.medicine net.com, (16.11.15)
Compassion Oct - Dec, 2015