Transcript
A CASE OF CONGENITAL PTOSIS
From department of Ophthalmology and Plastic surgery
A case of Congenital ptosis A CASE OF CONGENITAL PTOSIS
Dr Samuel Ponraj MS Ophthal [ 1 st year Pg]
• A 20 year old patient who complained of drooping of the left upper eyelid since birth
There was no similar complaints in the family O/E : -Severe ptosis > 4 mm of left upper eyelid -Absent lid crease -Bell’s phenomenon [ + ] - Poor levator function of < 5 mm - Normal frontalis action
Choice of operation : Frontalis sling operation
ABSENT LID CREASEPTOSIS > 4 mm
- Test for unilateral /bilateral severity of ptosis
- Measurement of MRD 1 [margin reflex distance]
MLD [ margin limbus distance]
MCD [ margin crease distance ]
- Upper lid excursion [Levator function]
-Bell’s phenomenon
- Marcus Gunn jaw-winking phenomenon
- Rule out Pseudoptosis
PREOPERATIVE ASSESSMENT
Evaluate for symptoms like Diplopia ,Dryness, Photophobia, Irritation which may worsen after surgery
Pupillary size Extraocular motility Examination of orbit Tensilon test [myasthenia gravis] Corneal staining [for keratopathy] Dilated fundus examination Imaging studies
PRE-OPERATIVE
IMMEDIATE POST OPERATIVE
POST OPERATIVE
CONGENITAL I. SimpleII. Complicated
ACQUIREDI. NeurogenicII. MyogenicIII. AponeuroticIV. Mechanical
CLASSIFICATION
Treatments of choice
• Fasanella – servat operation• Levator resection - Blaskoviks & Everbusch techniques• Frontalis suspension
THANK YOU
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