๐๐ฝ๐ผ๐ป๐ฒ๐๐ฟ๐ผ๐๐ถ๐ฐ ๐ฃ๐๐ผ๐๐ถ๐โฃ
โฃ
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.โฃ
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).โฃ
โ It may be unilateral/ bilateral.โฃ
โ It may be mild (1โ2 mm), moderate (3โ4 mm), or severe (>4 mm).
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โฃ
๐ง๐๐ฝ๐ฒ๐ ๐ผ๐ณ ๐ฎ๐ฐ๐พ๐๐ถ๐ฟ๐ฒ๐ฑ ๐ฝ๐๐ผ๐๐ถ๐:โฃ
โ Aponeuroticโฃ
โ Myogenic - Myasthenia Gravis, CPEO etcโฃ
โ Neurogenic- Hornerโs, 3rd nerve palsyโฃ โฃ
โ Mechanical- Lid tumoursโฃ
โฃ
๐พ๐๐ช๐จ๐๐จ ๐ค๐ ๐ผ๐ฅ๐ค๐ฃ๐๐ช๐ง๐ค๐ฉ๐๐ ๐ฅ๐ฉ๐ค๐จ๐๐จ:โฃ
โ Involutional โ Due to aging, levator muscle becomes thin โ loss of muscle tone and inability to hold the upper lid in proper positionโฃ
โ Post-trauma dehiscence/disinsertionโฃ
โ Post-ocular surgeryโฃ
โ Post eyelid edema (blepharochalasis)โฃ
โ Post contact lens wearโฃ
โฃ
๐๐น๐ถ๐ป๐ถ๐ฐ๐ฎ๐น ๐๐ฒ๐ฎ๐๐๐ฟ๐ฒ๐:โฃ
โ Drooping of eyelid with reduction of palpebral fissure heightโฃ
โ Elevated lid crease on the affected sideโฃ
โ Increased pre-tarsal show (margin- crease distance is increased)โฃ
โ Skin over eyelid is thinned outโฃ
โ Sulcus is deepโฃ
โ No lid lag on downgaze ie lid drops and ptosis worsens on downgaze โ symptoms worse on downgaze/ while readingโฃ
โ Patient may compensate with overaction of the frontalisโฃ
โ Good levator functionโฃ
โ Extraocular muscle movements and pupil are ๐ป๐ผ๐ involvedโฃ
โ Rule out myasthenia gravis - by looking for fatigability/ diurnal variabilityโฃ
โฃ
๐ ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐โฃ
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 muscleโฃ
โ The most commonly performed procedure:โฃ
๐๐๐ซ๐๐ฉ๐ค๐ง ๐ข๐ช๐จ๐๐ก๐ ๐๐๐ซ๐๐ฃ๐๐๐ข๐๐ฃ๐ฉ (๐ก๐๐ซ๐๐ฉ๐ค๐ง ๐๐ฅ๐ค๐ฃ๐๐ช๐ง๐ค๐ฉ๐๐ ๐ง๐๐ฅ๐๐๐ง):โฃ 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.โฃ
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