ptosis

eyes diseases, eyelid ,ocular diseases, ptosis examination, treatment of ptosis,

1. Examination of Ptosis 3 rd year bsc optometry NETHRADHAMA SCHOOL OF OPTO

2. Introduction Abnormal drooping of the upper eyelid is called Ptosis. Normally, upper eyelid covers about upper one sixth of cornea, i.e., about 2mm. Therefore in ptosis it covers more than 2mm.

3. Examination Examination include Evaluation Measurement of amount(degree) of ptosis Margin reflex distance Assessment of levator function Special investigation Photographic record

4. Evaluation Pseudoptosis (simulated ptosis ) should be excluded on inspection. Points to be observed: Whether ptosis is unilateral or bilateral. Function of orbicularis oculi muscle. Eyelid crease is present or absent. Jaw-winking phenomenon is present or not. Associated weakness of any extraocular muscle. Bell’s phenomenon( up and outrolling of the eyeball during forceful closure) is present or absent.

5. Measurement of amount (degree) of ptosis In unilateral cases, difference between the vertical height of the palpebral fissures of the two sides indicates the degree of ptosis . In bilateral cases it can be determined by measuring the amount of cornea covered by the upper lid and then subtracting 2mm. Ptosis is graded depending upon its amount as : Mild ptosis : 2mm Moderate ptosis : 3mm Severe ptosis : 4mm

6. Margin reflex distance Margin reflex distance (MRD) refers to the distance between the upper lid margins and corneal light reflex . Normal value of MRD is 4-5 mm.

7. Assessment of levator function It is measured by the lid excursion caused by LPS muscle (burke’s method). Patient is asked to look down, and thumb of one hand is placed firmly against the eyebrow of the patient by the examiner. Then the patient is asked to look up and the amount of upper lid excursion is measured with a ruler held in the other hand by the examiner Levator function is graded as follows: Normal: 15mm Good: 8mm or more Fair: 5-7 mm Poor: 4mm or less

8. Special investigation Tensilon test is performed when myasthenia is suspected. Phenylephrine test is carried out in patients suspected of Horner’s syndrome. Neurological investigations may be required to find out the cause in patient with neurogenic ptosis .

9. Photographic records Photographic records of the patient should be maintained for comparison. Photographs should be taken in primary position as well as in up and down gazes.

10. Thank you