Eyelids Flashcards
Aponeurotic
Main muscle works but ligament is too loose
Neuromuscular
Inhibition of NT excitation of muscle (e.g. MG)
Neurogenic
Issue w/ innervation
Myotonic
Dysfunction of muscle (e.g. Mitochondiral disorder)
Mechanical
Anything that manually pushes eyelid down
3 Muscles involved in lid elevation
- Levator (SupDiv of CN 3)
- Mullers (Sympathetic)
- Frontalis (CN 7)
Eyelid closure muscle
OO mm. (CN 7)
Dermatochalasis
Extra skin
!!
Acquired, painful ptosis of sudden onset, suspect:
- CN 3 palsy
- Horner’s
Test of Levator Function + Normal Values
Measure down gaze to upgaze
Normal: > 11 mm
Conditions w/ Normal Levator function
Levator Dehiscence (Aponeurotic) + Horner’s
Conditions w/ Abnormal Levator Function
- Congenital ptosis
- MG
- CN 3 Palsy
- Myopathic conditions (CPEO, MD)
MRD1
+ Normals
Corneal reflex to upper lid
Normal: ~4.5 mm
Abnormal: > 2 mm of 2 mm of asymmetry
Most common form of ptosis
Aponeurotic aka Involutional
Bilateral ptosis may be the only manifestations of…
CN 3 Palsy
Neuromuscular Ptosis Conditions
- MG
- Botulism
- Lambert-Eaton Syndrome
T/F: Myasthenis Gravis can be involved bilateral ptosis
TRUE; can be either
“Peek” sign
Force eyes close tightly —> fatigue —> eye opens slightly
Positive Ice Test
Ice pack (2-5 minutes) —> Ptosis improves by 2mm or more
Endrophonium (Tensilon Test)
Why not often performed clinically?
Low sensitivity, severe side effects (cardiac arrest)
Cohan Eyelid Twitch Phenomenon
Pt asked to look up, down, and straight
Quiver/twitch on upgaze is (+)
Specific/Sensitive test for MG
