PTOSIS -Measurement and clinical evaluation

This slide is very important for quick review of ptosis examination and evaluation and it is also important for clinical viva of ug students.

1. PTOSIS Evaluation and measurement Satish Kumar B.Optm . IGIMS, Patna

2. Ptosis About 2 mm of our cornea is covered by eyelids. If there is dropping of eyelids more than 2 mm is known as ptosis.

3. Ptosis Classification(Mechanistic)

4. Congenital Ptosis It can be divided in to two types 1.Congenital simple ptosis 2.Ptosis associated with Blepharophismosis Syndrome Double elevator palsy Marcus Gunn Jaw winkling

5. Congenital ptosis Blepharophismosis Syndrome Simple Congenital Ptosis

6. Characterisitics of Acquired Potsis 1.Neurogenic 3 rd Nerve Palsy Horner syndrome 2.Myogenic Myotonic dystrophy Myasthenia gravis Progressive external ophthalmoplegia 3.Mechanical By trauma 4.Aponeurotic Ptosis In Old age

7. Clinical Evaluation of ptosis 1. History - onset, duration or progressive Unilateral or bilateral Decreasing vision or diplopia Previous history of drugs as topical steroid Family history of ptosis. 2.Ocular Examination Visual Acuity Eye Position and ocular motility Pupil Examination Rule out pseudoptosis – Ipsilateral microhthalmia , anoptalmia , pthysis bulbi Ipsilateral hypotropia Contralateral lid retraction

8. Clinical Evaluation of ptosis

9. Clinical Evaluation of ptosis Mild ptosis – 2mm drop Moderate ptosis- 3mm drop Severe ptosis – 4mm drop MRD 1 may be negative…………… 5. Lid Crease – Marginal fold distance (Primary Gaze) Marginal crease distance ( Downgaze )

10. Clinical Evaluation of ptosis 6. Levator functions. Brebe’s method – in it we press the frontalis muscles near eyebrow and tell the patient to close eye and open wide and then we measure the height. Putterman’s method – in it we tell the patient to look in up gaze then we measure the distance from upper marzine to 6 o clock limbs. Lli f methods – it is mainly done in Childs we revert the eyelid of child if it revert then the lps functions is normal.

11. Clinical Evaluation of ptosis 7. Bell’s Phenomenon test 1 st Method – Open the eye manually and tell the patient to close eye. 2 nd Method – tell the patient of close eye forcefully and we try to elevate the upper lid then we examine the position of cornea. Normal – Up and inward Reverse – down and outward Perverse – any direction Grading – Good - >2/3 rd , Fair – 1/3 rd to 2/3 rd , Poor - <1/3 rd

12. Clinical Evaluation of ptosis 8. Corneal Sensation – always comes form temporal side. 9. Jaw-blinking phenomenon- 10. Increased innervation – To see the status of other eye after surgery Pull up the normal eye and see the dropping of upper eyelid.

13. Rule out mysthania gravis Tensilon test Ice pack test Phenylephrine test

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