The Eyelid PDF

The Eyelid PTOSIS ▪ Definition: - It is drooping of the upper eye lid which is normally covers upper 1/6 (or upper 2 mm) of the cornea. ▪ Aetiology: a) Congenital: Fig. (2-5) b) Acquired - Neurogenic:.. Occlumotor nerve palsy (paralysis...

The Eyelid PTOSIS ▪ Definition: - It is drooping of the upper eye lid which is normally covers upper 1/6 (or upper 2 mm) of the cornea. ▪ Aetiology: a) Congenital: Fig. (2-5) b) Acquired - Neurogenic:.. Occlumotor nerve palsy (paralysis of levator muscle)... Sympathetic paralysis (paralysis of Muller's muscle). - Myogenic: (myaesthenia gravis and muscle dystrophy). - Apponeurotic: (involutional ptosis and post-operative ptosis). - Traumatic - Mechanical: (heaviness of the lid by chalazion or lid tumours) - Hysterical ptosis. Fig. (2-5): Congenital Ptosis ▪ Examination (evaluation) of a case of ptosis: 1- History: - Age of onset, history of fever, history of trauma and family history. 2- Exclude pseudoptosis: - Upper lid lacks its normal support (microphthalmos and enophthalmos) - Contralateral lid retraction. 3- Measurements: - Marginal reflex distance (MRD): _____________________________________________________________________________ - 10 -  The Eyelid.. Distance between the lid margin and the corneal light reflex.. It estimates the severity of ptosis. - Levator function (upper lid excursion):.. Ask the patient to look down, fix the frontalis muscle by pressure on the eyebrow, then ask the patient to look up after fixing a ruler on the lid margin and measure the excursion... If 12 mm = good, 6 - 11 mm = fair and 5 mm or less = poor function. 4- Associated signs: - Jaw-winking (Marcus Gunn’s phenomenon): elevation of the ptosed lid with the movement of the jaw. It is due to faulty innervation between occulomotor nerve (3rd) nerve supplying the levator and mandibular division of the trigeminal (5th) nerve supplying muscles of mastications. - Superior rectus weakness. - Epicanthus. ▪ Surgical treatment of ptosis: Indications: - Congenital ptosis. - Acquired ptosis when the treatment of the cause has failed or is impossible Contraindications: - Complete third nerve paralysis with diplopia. - Corneal anaesthesia or absence of Bell’s phenomenon. Time of surgery: o If the degree of ptosis is severe and pupillary area is covered → surgical interference as early as possible to avoid amblyopia o In mild and moderate ptosis (partial ptosis) in which the pupil is uncovered with no affection of the vision → postpone till 5 years (preschool age) Type of operation: o Fasanella Servat operation Fig. (2-6).. Indicated in mild ptosis due to Muller muscle weakness.. It involves resection Muller muscle though a conjunctival approach _____________________________________________________________________________ - 11 -  The Eyelid Fig. (2-6): Fasanella Servat operation o Levator resection operation.. Indicated in mild or moderate ptosis due to levator weakness.. Levator function is good.. It involves resection of levator muscle through:. Skin approach → Everbusch’s operation. Conjunctival approach → Blascovics operation. Fig. (2-7) Fig. (2-7): Blascovics operation o Sling operations Fig. (2-8).. Indicated severe ptosis.. Levator function is poor (levator muscle is completely paralyzed).. The lid is elevated either by:. Fascia lata. Mersaline mesh. Frontalis muscle sling _____________________________________________________________________________ - 12 -  The Eyelid Fig. (2-8): Sling Operation _____________________________________________________________________________ - 13 -