CLASSIFICATION OF PTOSIS - PowerPoint Presentation

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CLASSIFICATION OF PTOSIS

N.İREM ABDULHAYOĞLU

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Blepharoptosis or ptosis is defined as drooping of the upper eyelid

.

Can affect all age groups and may be congenital or acquired.

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Anatomy

The muscles responsible for eyelid

retraction:Levator palpebrae superioris;

under voluntary control from CN III.Müller's muscle; contributes 1-2 mm of eyelid elevation and

i

t

is under sympathetic

innervation

.

F

rontalis

muscle

;

lifts the brows and is a minor contributor to eyelid

retraction

a

nd

i

t

is innervated by CN

VII

.

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Classification

A.

CongenitalB. Acquired 1.Neurogenic 2.Myogenic 3.Aponeurotic 4.Mechanical

C. Pseudoptosis

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A.Congenital Ptosis

Simple congenital ptosis

weakness of levator muscle most cases are this type when patient born with this problem

most often sporadic but can be inheritedCongenital ptosis with weakness of superior rectus muscle(the muscle that makes the eyeball look up)about 1 in 20 cases have the added eye muscle weaknessPtosis with blepharophimosis syndromedominant hereditary conditionSynkinetic

ptosis

involuntary motion of eyelid with attempted desired motion

Marcus-Gunn jaw winking ptosis

misdirected

3rd nerve ptosis

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Blepharophimosis syndrome(BPES)

narrowing of the eye opening

(blepharophimosis)droopy eyelids (ptosis)

upward fold of the skin of the lower eyelid near the inner corner of the eye (epicanthus inversus) increased distance between the inner corners of the eyes (telecanthus)

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Marcus Gunn

jaw-winking syndrome (Congenital Trigemino-oculomotor synkinesis)Characterized by eyelid

synkinesis with jaw movement.Accounts for about 5% of all cases of congenital ptosis.

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B.Acquired Ptosis

1. NEUROGENIC PTOSIS

Oculomotor nerve palsy Horner’s syndrome

Myasthenia gravis Synkinetic ptosis Guillain-Barré syndrome Cerebral

ptosis

Botulism

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Oculomotor nerve

palsy

Characterized by a variable degree of ptosis associated with deficits

of adduction, elevation, and depression of the

eye

due

to

weakness

of

the

levator

muscle

,

the

superior

,

inferior

and

medial

rectus

muscles

and

the

inferior

oblique

muscle

.

Palsy

may

be

caused

by

neoplastic

,

inflammatory

,

vascular

or

traumatic

lesions

.

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Patients may present with any combination of ptosis, ophthalmoplegia, diplopia, and a poorly-reactive dilated

pupil

.

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Horner's syndrome

(

oculosympathetic paresis)Ptosis (1-2mm)MiosisFacial anhidrosisEnophtalmos

Damage anywhere along the sympathetic pathway; -first order neurons (hypothalamus to spinalcord

)

-

 second order neurons (spinal cord to superior cervical ganglion

)

-

third order neuron (superior cervical ganglion to orbit)

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Myasthenia gravis

I

n 85% of patients with myasthenia, the initial symptoms were either ptosis or diplopia.Bilaterally or unilaterally Ptosis

can change on a minute-to-minute basis. Classically the ptosis is more severe in the evening.

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Cogan's

lid

twitch: rapid saccades from downgaze to the primary position may provoke an overshoot

of the upper eyelid.Tensilon test(edrophonium chloride):

Tensilon

is a

short

acting

anticholinesterase

agent

and

it

will

temporarily

overcome

the

muscle

weakness

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2.

MYOGENIC PTOSISCongenital dystrophy of the

levator muscleMyotonic dystrophyChronic progressive external ophtalmoplegiaTraumatic

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Myotonic dystrophy

 A defining feature of the disease is

myotonia, or a failure of the muscle to relax. Eventually leads to facial and peripheral muscle weakness. Christmas

tree cataracts Frontal balding Intellectual impairment

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Chronic progressive external

ophthalmoplegia

(CPEO)Mitochondrial myopathy Symmetric, bilateral ptosis and ophthalmoparesis typically in their 30'sKearns-Sayre

syndrome : CPEO and retinitis pigmentosa

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3.

APONEUROTIC PTOSIS 

Defects in the levator aponeurotic linkage(between the

levator muscle and the tarsal plate) in the presence of a normal functioning muscle. Involutional

(

senile

)

Postoperative

Post

eyelid

trauma

Post

eyelid

edema

Post

contact

lens

wear

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Involutional ptosis

Ptosis

that is constant in all position of gazeLid drop on downgaze

Good levator functionHigh skin creaseThinning of the eyelid

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4.

MECHANICAL PTOSISDue to excessive weight on the upper lid; Eyelid tumors Orbital lesions

Cicatrizing conjunctival disorders

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C.Pseudoptosis

The eyelid appears to be lowered but there is no pathology of the eyelid muscles or aponeurosis. Contralateral eyelid retraction Hemifacial spasm

Dermatochalasis(an excess of skin in the upper eyelid)/brow ptosis Aberrant reinnervation

of

the

facial

nerve

Double

elevator

palsy

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REFERENCES

Oculoplastic

Surgery - Brian LeatherbarrowGöz Hastalıkları - Gerhard K. Langhttps://www.aao.org/eye-health/diseases/ptosis-treatmenthttp://

webeye.ophth.uiowa.edu/eyeforum/tutorials/ptosis/index.htm

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Thank you…