Lid/ ptosis examination Flashcards
What are 12 parts of lid/ptosis examination?
- Shake hands to check for myotonia
- Observe: face, brow, globes, lids, pupils
- Measure: palpebrale aperture, upper margin reflex distance, position of upper lid crease, levator function
- Measure any lagophthalmos
- Assess orbicularis function and Bell’s phenomenon
- Assess fatiguability over 1 min
- Examine for Cogan’s twitch
- Assess for jaw-winking
- Biomicroscope examine of lid and subtarsal conjucntiva
- Check corneal sensation
- Examine ocular motility
- Examine pupils
What is a sign to look for when shaking hands?
to note slow release of grip
What are 5 things to observe as part of the lids/ptosis examination?
- Face
- Brow
- Globes
- Lids
- Pupils
What are 4 things to measure in the measurement stage of the lid/ptosis examination?
- Palpebral aperture
- Upper margin reflex distance
- Position of upper lid crease
- Measure levator function
How can levator function be measured?
inhibit frontalis by placing a thumb on the brow
What is lagophthalmos?
incomplete or abnormal closure of the eyelids
How can lagophthalmos be assessed?
ask pt to close eyes, gently at first, then ask to squeeze eyes shut
How can orbicularis function and Bell’s phenomenon?
try to open patient’s eyes against resistance
How can fatiguability be assessed and what should you look for?
pt to keep looking upward at a target held superiorly for 1 min, assess for any worsening of ptosis - assess for lid drifting down, reassess palpebral aperture in primary position at the end
How do you examine for Cogan’s twitch?
ask patient to look down and then to look at a target held directly in front of them
What is Cogan’s twitch?
overshoot of the eyelid which occurs on rapid elevation of the eyes from downgaze to the primary position
What condition may Cogan’s twitch be seen in?
myasthenia
Wha is jaw-winking?
lid can be elevated by movement of the jaw e.g. chewing, side to side movement of jaw
What can cause jaw-winking?
synkinesis (mis-wiring), resulting in ptosis which varies with use of other facial muscles (pterygoids) - form of congenital ptosis
What are 2 ways to assess for anisocoria?
response to light and near
What should be the next step if fatiguability is demonstrated on examination?
examine for associated fatiguability of ocular motility and general musculature - usually a sign of myasthenia
What specific test can be considered for myasthenia?
ice pack test (and further investigation)
What specific test can be considered for myasthenia?
ice pack test (and further investigation)
What is the normal range for palpebral aperture measurement?
8-11mm
Which gender tends to have greater palpebral aperture?
female
What is the normal range for upper margin reflex distance?
4-5mm
What is the normal range for upper lid excursion (levator function)?
13-16mm
What is the normal range for upper lid crease position?
8-10mm from margin
Which gender tends to have a higher upper lid crease position?
female
What is the upper margin reflex distance?
measurement in millimeters from the light reflex on the patient’s cornea to the level of the center of the upper-eyelid margin, with the patient gazing in the primary position
What is the upper lid excursion (levator function)?
distance from the upper eyelid margin in downgaze to upgaze, with frontalis muscle function neutralized
