Disease of the Eyelid

PTOSIS

DEF: Drooping of upper eyelid weakness or paralysis of the levator palpebrae superioris.

SYMPTOMS & SIGN

1. Bad cosmetic appearance of the drooping upper lid

2. Interference with vision: if pupillary area is covered -Amblyopia

3. Elevation of eyebrows & wrinkling of skin of forehead

4. Compensatory backword Head tilt -when condition is severe & bilateral

5. In marked ptosis -superior palpebral fissure is Absent

6. In paralytic ptosis -there may be partial or complete Ophthalmoplegia

CAUSES OF PTOSIS

CONGENITAL PTOSIS

* since birth & it usually hereditary or bilateral

* it may simple due to poor development or absent of levator musle

* Epicanthus,telecanthus & blepharo-phimosis -blepharo-phimosis syndrome

ACQUIRED PTOSIS

* Mechanical ptosis - due to increased weight of lid

e.g :multiple Chalazia,amyloid, hyaline degeneration

* Traumatic ptosis - mechanical effect of hge,edema,emphysema

-injury of levator ms

-traumatic scarring

* Neurogenic ptosis - levator ms paralysis due to 3rd nerve palsy

- Muller's ms paralysis due to sympathetic paralysis -as in Horner's syndrome

-Marcuss- Gunn syndrome (Jaw winking ptosis)

* Myogenic ptosis -Myasthenia Gravis

- Myotonic Dystropy

- Chronic progressive external ophthalmoplegia

* Hysterical ptosis - usually in young female with some emotional troubles

- may be unilateral or bilateral

-characterized by -trembling of ptotic lid

- behavior of patient

- no frowning of forehead

* Pseudo ptosis - due to loss of posterior support of upper lid

* Senile ptosis - primary weakness of levator ms or aponeurotic defefect

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