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Drooping lid!

๐—”๐—ฝ๐—ผ๐—ป๐—ฒ๐˜‚๐—ฟ๐—ผ๐˜๐—ถ๐—ฐ ๐—ฃ๐˜๐—ผ๐˜€๐—ถ๐˜€โฃ


โ— It is the most common form of acquired ptosis due to dehiscence or disinsertion of the levator aponeurosis for anterior surface of the tarsus.โฃ

โ— 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).โฃ

โ— It may be unilateral/ bilateral.โฃ

โ— It may be mild (1โ€“2 mm), moderate (3โ€“4 mm), or severe (>4 mm).



๐—ง๐˜†๐—ฝ๐—ฒ๐˜€ ๐—ผ๐—ณ ๐—ฎ๐—ฐ๐—พ๐˜‚๐—ถ๐—ฟ๐—ฒ๐—ฑ ๐—ฝ๐˜๐—ผ๐˜€๐—ถ๐˜€:โฃ

โ— Aponeuroticโฃ

โ— Myogenic - Myasthenia Gravis, CPEO etcโฃ

โ— Neurogenic- Hornerโ€™s, 3rd nerve palsyโฃ โฃ

โ— Mechanical- Lid tumoursโฃ


๐˜พ๐™–๐™ช๐™จ๐™š๐™จ ๐™ค๐™› ๐˜ผ๐™ฅ๐™ค๐™ฃ๐™š๐™ช๐™ง๐™ค๐™ฉ๐™ž๐™˜ ๐™ฅ๐™ฉ๐™ค๐™จ๐™ž๐™จ:โฃ

โ— Involutional โ†’ Due to aging, levator muscle becomes thin โ†’ loss of muscle tone and inability to hold the upper lid in proper positionโฃ

โ— Post-trauma dehiscence/disinsertionโฃ

โ— Post-ocular surgeryโฃ

โ— Post eyelid edema (blepharochalasis)โฃ

โ— Post contact lens wearโฃ


๐—–๐—น๐—ถ๐—ป๐—ถ๐—ฐ๐—ฎ๐—น ๐—™๐—ฒ๐—ฎ๐˜๐˜‚๐—ฟ๐—ฒ๐˜€:โฃ

โ— Drooping of eyelid with reduction of palpebral fissure heightโฃ

โ— Elevated lid crease on the affected sideโฃ

โ— Increased pre-tarsal show (margin- crease distance is increased)โฃ

โ— Skin over eyelid is thinned outโฃ

โ— Sulcus is deepโฃ

โ— No lid lag on downgaze ie lid drops and ptosis worsens on downgaze โ†’ symptoms worse on downgaze/ while readingโฃ

โ— Patient may compensate with overaction of the frontalisโฃ

โ— Good levator functionโฃ

โ— Extraocular muscle movements and pupil are ๐—ป๐—ผ๐˜ involvedโฃ

โ— Rule out myasthenia gravis - by looking for fatigability/ diurnal variabilityโฃ


๐— ๐—ฎ๐—ป๐—ฎ๐—ด๐—ฒ๐—บ๐—ฒ๐—ป๐˜โฃ

โ— 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 muscleโฃ

โ— The most commonly performed procedure:โฃ

๐™‡๐™š๐™ซ๐™–๐™ฉ๐™ค๐™ง ๐™ข๐™ช๐™จ๐™˜๐™ก๐™š ๐™–๐™™๐™ซ๐™–๐™ฃ๐™˜๐™š๐™ข๐™š๐™ฃ๐™ฉ (๐™ก๐™š๐™ซ๐™–๐™ฉ๐™ค๐™ง ๐™–๐™ฅ๐™ค๐™ฃ๐™š๐™ช๐™ง๐™ค๐™ฉ๐™ž๐™˜ ๐™ง๐™š๐™ฅ๐™–๐™ž๐™ง):โฃ 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.โฃ

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