Look at the picture above. What is the most likely cause for this woman's upper lid appearance?

Answer
This woman has bilateral ptosis with high skin creases. This is characteristic 
of levator dehiscence. The most most cause is involutional (ie. age-related). 
Other possible causes include previous intraocular operation and trauma.

How would you classify ptosis?

Answer
Myogenic such as myasthenia gravis,  chronic progressive
external ophthalmoplegia and blepharophimosis
Mechanical from scar or tumour
Aponeurotic caused by dehiscence of the levator aponeurosis
as in old age or following intraocular surgery
Neurogenic such as third nerve palsy and Horner's syndrome

What is meant by pseudoptosis? Give me some examples.

Answer
Pseudoptosis refers to the appearance of ptosis although ptosis is absent.
It can be causes by:
1. Ipsilateral enopthalmos such as anophthalmos, blow-out fracture and phthisis bulbi
2. Contralteral eyelid retraction as in thyroid eye disease
3. Contralteral proptosis
 
 

Here is a child with ptosis since birth. What would be the most important examination?

Answer
Testing of visual acuity and refraction.
Congenital ptosis is associated with ametropia especially astigamtism. 
If the vision is down and the patient is ametropia. Glasses will be required to prevent amblyopia.

How could you decide clinically if this child's ptosis is caused by a dystrophic levator?

Answer
In congenital ptosis caused by dystrophic levator, the levator is frequently 
infiltrated by fatty tissue. Clinically, the levator function is poor usually less 
than 10 mm. In addition, it fails to relax on downgaze so that there is lid lag when the patient looks down.
 

What other ocular sign may be present?

Answer
The ipsilateral superior rectus may also be maldeveloped resulting in poor globe elevation on upgaze.
 
 

More questions