𝗔𝗽𝗼𝗻𝗲𝘂𝗿𝗼𝘁𝗶𝗰 𝗣𝘁𝗼𝘀𝗶𝘀
● It is the most common form of acquired ptosis due to dehiscence or disinsertion of the levator aponeurosis for anterior surface of the tarsus.
● The Levator palpebrae superioris is the primary muscle responsible for the elevation of the eyelid. It is supplied by the third cranial nerve (superior division).
● It may be unilateral/ bilateral.
● It may be mild (1–2 mm), moderate (3–4 mm), or severe (>4 mm).
𝗧𝘆𝗽𝗲𝘀 𝗼𝗳 𝗮𝗰𝗾𝘂𝗶𝗿𝗲𝗱 𝗽𝘁𝗼𝘀𝗶𝘀:
● Aponeurotic
● Myogenic - Myasthenia Gravis, CPEO etc
● Neurogenic- Horner’s, 3rd nerve palsy
● Mechanical- Lid tumours
𝘾𝙖𝙪𝙨𝙚𝙨 𝙤𝙛 𝘼𝙥𝙤𝙣𝙚𝙪𝙧𝙤𝙩𝙞𝙘 𝙥𝙩𝙤𝙨𝙞𝙨:
● Involutional → Due to aging, levator muscle becomes thin → loss of muscle tone and inability to hold the upper lid in proper position
● Post-trauma dehiscence/disinsertion
● Post-ocular surgery
● Post eyelid edema (blepharochalasis)
● Post contact lens wear
𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗙𝗲𝗮𝘁𝘂𝗿𝗲𝘀:
● Drooping of eyelid with reduction of palpebral fissure height
● Elevated lid crease on the affected side
● Increased pre-tarsal show (margin- crease distance is increased)
● Skin over eyelid is thinned out
● Sulcus is deep
● No lid lag on downgaze ie lid drops and ptosis worsens on downgaze → symptoms worse on downgaze/ while reading
● Patient may compensate with overaction of the frontalis
● Good levator function
● Extraocular muscle movements and pupil are 𝗻𝗼𝘁 involved
● Rule out myasthenia gravis - by looking for fatigability/ diurnal variability
𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁
● The goal of surgery is to reattach a disinserted or dehisced aponeurosis to the superior anterior surface of the tarsus, or shorten and tighten a weak levator muscle
● The most commonly performed procedure:
𝙇𝙚𝙫𝙖𝙩𝙤𝙧 𝙢𝙪𝙨𝙘𝙡𝙚 𝙖𝙙𝙫𝙖𝙣𝙘𝙚𝙢𝙚𝙣𝙩 (𝙡𝙚𝙫𝙖𝙩𝙤𝙧 𝙖𝙥𝙤𝙣𝙚𝙪𝙧𝙤𝙩𝙞𝙘 𝙧𝙚𝙥𝙖𝙞𝙧): Through an upper eyelid crease incision, the levator aponeurosis is surgically dissected from the tarsus and identified from the overlying orbital fat. A partial thickness suture is passed through the tarsus and through the levator muscle, resulting in an advancement of the levator muscle.
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