Eyelids

Question 1

Aponeurotic

Answer 1

Main muscle works but ligament is too loose

Question 2

Neuromuscular

Answer 2

Inhibition of NT excitation of muscle (e.g. MG)

Question 3

Neurogenic

Answer 3

Issue w/ innervation

Question 4

Myotonic

Answer 4

Dysfunction of muscle (e.g. Mitochondiral disorder)

Question 5

Mechanical

Answer 5

Anything that manually pushes eyelid down

Question 6

3 Muscles involved in lid elevation

Answer 6

1. Levator (SupDiv of CN 3)
2. Mullers (Sympathetic)
3. Frontalis (CN 7)

Question 7

Eyelid closure muscle

Answer 7

OO mm. (CN 7)

Question 8

Dermatochalasis

Answer 8

Extra skin

Question 9

!!
Acquired, painful ptosis of sudden onset, suspect:

Answer 9

1. CN 3 palsy
2. Horner’s

Question 10

Test of Levator Function + Normal Values

Answer 10

Measure down gaze to upgaze
Normal: > 11 mm

Question 11

Conditions w/ Normal Levator function

Answer 11

Levator Dehiscence (Aponeurotic) + Horner’s

Question 12

Conditions w/ Abnormal Levator Function

Answer 12

1. Congenital ptosis
2. MG
3. CN 3 Palsy
4. Myopathic conditions (CPEO, MD)

Question 13

MRD1
+ Normals

Answer 13

Corneal reflex to upper lid
Normal: ~4.5 mm
Abnormal: > 2 mm of 2 mm of asymmetry

Question 14

Most common form of ptosis

Answer 14

Aponeurotic aka Involutional

Question 15

Bilateral ptosis may be the only manifestations of…

Answer 15

CN 3 Palsy

Question 16

Neuromuscular Ptosis Conditions

Answer 16

1. MG
2. Botulism
3. Lambert-Eaton Syndrome

Question 17

T/F: Myasthenis Gravis can be involved bilateral ptosis

Answer 17

TRUE; can be either

Question 18

“Peek” sign

Answer 18

Force eyes close tightly —> fatigue —> eye opens slightly

Question 19

Positive Ice Test

Answer 19

Ice pack (2-5 minutes) —> Ptosis improves by 2mm or more

Question 20

Endrophonium (Tensilon Test)
Why not often performed clinically?

Answer 20

Low sensitivity, severe side effects (cardiac arrest)

Question 21

Cohan Eyelid Twitch Phenomenon

Answer 21

Pt asked to look up, down, and straight

Quiver/twitch on upgaze is (+)

Specific/Sensitive test for MG