2. ORBIT, EYELIDS AND LACRIMAL SYSTEM-AAO
2015-16
YANOFF,DUKER OPHTHALMOLOGY FOURTH
EDITION
KANSKI CLINICAL OPHTHALMOLOGY EIGHT
EDITION
ALBERT AND JAKOBIEC’S PRINCIPLES AND
PRACTICE OF OPHTHALMOLOGY THIRD
EDITION
5. 1857- Bowman described shortening of levator muller muscle
complex through a conjunctival incision
1883- Everbusch and Snellen reported anterior levator resection
1897-Motais and Perinaud described superior rectus suspension
1975- Jones published the successful repair of acquired ptosis by
levator aponeurotic reattachment or resection.
12. (A) Decreased levator muscle function occurs
along with an indistinct upper eyelid crease.
(B) The ptosis is exaggerated in upgaze
due to the poor function of the levator muscle.
(C) In downgaze, the ptosis is
reduced or absent because the fibrotic levator muscle cannot stretch.
a) b) c)
15. Introduction: Ptosis + ophthalmoplegia
Clinical features:
Gene
Types:
TYP
E
PTOSIS GLOBE INHERITA
NCE
GENE COMME
NTS
1 B/L INFRADUC
TION
AD 12p11.
2-q12
CHIN UP
2 B/L EXOTROPIA AR 11q IRANIAN
/MID
EAST
3 VARIABL
E
VARIABLE AD 16q24.
2-24.3
VERTICA
L
LIMITAT
ION
4 U/L VARIABLE SPORADI
C
-
36. CONGENITAL
MYOGENIC PTOSIS
ACQUIRED
APONEUROTIC PTOSIS
Mild to severe
ptosis
Poorly formed
Reduced
Lid lag
Mild to severe
ptosis
Higher than
normal or absent
Near normal
Eyelid drop
1.MRD 1
2.Upper
eyelid crease
3. Levator
function
4. Downgaze
37. 1. HISTORY
Age of onset
Progression
Family history
Marked variability in degree of ptosis during day
Diplopia
Presence of dysphonia, dypnoea,dysphagia or proximal
muscle weakness
39. 1. Head position, chin elevation,brow position
and brow action-
2. Quantity and quality of tear film
3. Bell’s phenomenon
4. Corneal sensation
5. Synkinesis
6. Herring’ law
7. Position of ptotic eyelid in downgaze