Ptosis

Question 1

Types of causes of ptosis

Answer 1

Neurogenic , Myogenic , neuromyopathic, Aponeurotic (involutional), Mechanical

Question 2

Pseudoptosis

Answer 2

artificial eye, microphthalmos, phthisis bulbi, or enophthalmos • Contralateral lid retraction • Ipsilateral hypotropia • Brow ptosis • Dermatochalasis

Question 3

Margin–reflex distance

Answer 3

4–5 mm

Question 4

Palpebral fissure height

Answer 4

The upper lid margin normally rests about 2 mm below the upper limbus and the lower 1 mm above the lower limbus. shorter in males (7–10 mm) than in females (8–12 mm).

Question 5

Ptosis - podział i ile mm

Answer 5

Ptosis - mild (up to 2 mm), moderate (3 mm) and severe (4 mm or more)

Question 6

Levator function (upper lid excursion)

Answer 6

thumb firmly against the patient’s brow, with the eyes in downgaze. looks up as far as possible. Levator function is graded as normal (15 mm or more), good (12–14 mm), fair (5–11 mm) and poor (4 mm or less)

Question 7

Upper lid crease (fałd) - definition

Answer 7

vertical distance between the lid margin and the lid crease in downgaze

Question 8

Upper lid crease (fałd) - normal value

Answer 8

females 10 mm, males 8 mm

Question 9

Upper lid crease (fałd) - Absence

Answer 9

in a patient with congenital ptosis is evidence of poor levator function

Question 10

Upper lid crease (fałd) - high crease

Answer 10

suggests an aponeurotic defect (usually involutional)

Question 11

Simple congenital ptosis

Answer 11

○ Absent upper lid crease and poor levator function. ○ In downgaze the ptotic lid is higher than the normal because of poor relaxation of the levator muscle. This is in contrast to acquired ptosis, in which the affected lid is either level with or lower than the normal lid on downgaze. ○ Following surgical correction the lid lag in downgaze may worsen.

Question 12

Marcus Gunn jaw-winking syndrome - cause

Answer 12

Branch of the mandibular division of the fifth cranial nerve is misdirected to the levator muscle. stimulation of the ipsilateral pterygoid muscles

Question 13

Marcus Gunn jaw-winking syndrome - treatment

Answer 13

Mild cases with reasonable levator function of 5 mm or better, and little synkinetic movement may be treated with unilateral levator advancement.

Question 14

Third nerve misdirection syndromes - treatment

Answer 14

levator disinsertion and brow suspension

Question 15

Involutional (aponeurotic) ptosis - causes

Answer 15

dehiscence (rozejście się), disinsertion (odcięcie ścięgna od przyczepu) or stretching of the levator aponeurosis

Question 16

Involutional (aponeurotic) ptosis - features

Answer 16

worsens towards the end of the day. usually bilateral ptosis with a high upper lid crease and good levator function. In severe cases the upper lid crease may be absent, the eyelid above the tarsal plate very thin and the upper sulcus deep

Question 17

Involutional (aponeurotic) ptosis - treatment

Answer 17

levator resection, advancement with reinsertion or anterior levator repair