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CLASSIFICATION OF PTOSIS

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Presentation on theme: "CLASSIFICATION OF PTOSIS"— Presentation transcript:

1 CLASSIFICATION OF PTOSIS
N.İREM ABDULHAYOĞLU

2 Blepharoptosis or ptosis is defined as drooping of the upper eyelid.
Can affect all age groups and may be congenital or acquired.

3 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 it is under sympathetic innervation. Frontalis muscle; lifts the brows and is a minor contributor to eyelid retraction and it is innervated by CN VII.

4

5 Classification A. Congenital B. Acquired 1.Neurogenic 2.Myogenic 3.Aponeurotic 4.Mechanical C. Pseudoptosis

6 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 inherited Congenital 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 weakness Ptosis with blepharophimosis syndrome dominant hereditary condition Synkinetic ptosis involuntary motion of eyelid with attempted desired motion Marcus-Gunn jaw winking ptosis misdirected 3rd nerve ptosis

7 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)

8 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.

9 B.Acquired Ptosis 1. NEUROGENIC PTOSIS Oculomotor nerve palsy
Horner’s syndrome Myasthenia gravis Synkinetic ptosis Guillain-Barré syndrome Cerebral ptosis Botulism

10 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.

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

12 Horner's syndrome (oculosympathetic paresis)
Ptosis (1-2mm) Miosis Facial anhidrosis Enophtalmos 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)

13 Myasthenia gravis In 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.

14 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

15 2. MYOGENIC PTOSIS Congenital dystrophy of the levator muscle
Myotonic dystrophy Chronic progressive external ophtalmoplegia Traumatic

16 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

17 Chronic progressive external ophthalmoplegia (CPEO)
Mitochondrial myopathy  Symmetric, bilateral ptosis and ophthalmoparesis typically in their 30's Kearns-Sayre syndrome : CPEO and retinitis pigmentosa

18 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

19 Involutional ptosis Ptosis that is constant in all position of gaze
Lid drop on downgaze Good levator function High skin crease Thinning of the eyelid

20 4. MECHANICAL PTOSIS Due to excessive weight on the upper lid;
Eyelid tumors Orbital lesions Cicatrizing conjunctival disorders

21 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

22 REFERENCES Oculoplastic Surgery - Brian Leatherbarrow
Göz Hastalıkları - Gerhard K. Lang health/diseases/ptosis-treatment ials/ptosis/index.htm

23 Thank you…


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