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