PTOSIS (DROOPY EYELID)

PTOSIS (DROOPY EYELID)

DEFINITION

– Drooping or falling of upper or lower eyelid is called as Ptosis or droopy eyelid.

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* Classification

 

1) Congenital

2) Acquired :

✓ Neurogenic

✓ Myogenic

✓ Aponeurotic

✓ Mechanical

✓ Neurotoxic..

(1) Congenital ptosis

– It is assoSiated with the congenital weakness of levator palpebrae superiors

a) Simple Congenital Ptosis

b) Congenit ptosis

c) Blepharophimosis syndrome

d) congenital synkinetic ptosis

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(2) Acquired ptosis

– It is caused by ;

• Neurogenic :

√ innervational defects such as 3 rd nerve palsy.

√ cerebral palsy

√ horner’s syndrome

√ Multiple sclerosis

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• Myogenic

 

√ myasthenia gravis

√ myotonic dystrophy

 

• Aponeurotic

√ involutional

√ post surgical

 

• Mechanical

√ tumor

√ swelling .

 

(3) Pseudo ptosis

 

√ Ipsilateral hypotropia

√ dermatochalasis

√ Enopthalmus

√ double elevator palsy

√ Blepharospasm

√ Brown ptosis

√ contralateral exoptalmus.

* Evaluation

 

– Observation of head posture

Chin elevation and frontalis overaction indicates severe ptosis.

 

– History

 

✓ Age of onset

✓ duration

✓ unilateral or bilateral

✓ diplopia

✓ Muscle weakness

✓ Muscle weakness

✓ Trauma

 

– Examination

 

✓ head posture

✓ Periocular fullness

✓ Frontalis overaction

✓ Scar mark

✓ ocular motility

✓ lid skin laxity

✓ visual activity

✓ Refraction.

 

– Measurements

 

✓ Margin reflex distance 1

✓ Margin reflex distance 2

✓ Margin reflex distance 3

✓ palpebral fissure height

✓ Margin limbal distance

– Levator function test.

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A) Marcus Gunn jaw winking

 

– Unilateral ptotic eyelid elevation along with movement of jaw occurs due to cross innervations between the oculomotor nerve and mandibular branch of trigeminal nerve .

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B) Bell’s phenomenon

 

– The eye moves generally upwards and outwards during eyelid closure.

– Corneal sensation test

– Corgans lid twitch sign

– Edrophonium test

– Ice test.

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* Surgical management

 

1) Mild ptosis

• Phenylephrine ( + ve ) : mullerectomy

• Phenylephrine (- ve) : fasanella servat.

• Blepharoplasty : levator resection.

 

2) Moderate ptosis

 

– levator resection

– levator advancement

 

3) Severe ptosis

– Frontalis sling.

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PHYSIOTHERAPY MANAGEMENT 

Exercise 1 :

 

-Eyes are closed

– Put index fingers of each hand at the far end of each of the eyebrows, then place  thumbs over the top of the cheekbones.

-Now, open the eyes wide and with the four fingers stretch the skin towards the temples.

– In this position, breathe deeply and inhale while trying to close the eyes.

Exercise 2 :

 

– Close your eyes tightly for about 5 seconds, then open them gradually.

-Repeat several times .

Exercise 3 :

 

– Place the index fingers on each eyebrows and put downward pressure.

– While applying pressure, try to raise the eyebrows and repeat for at least 15 times.

Exercise 4 :

 

– Position : Sitting in a chair ( back and neck upright).

– Look at the ceiling ( only with the eyes, without moving head )

-Then, start making circles with both the eyes in the direction of the needles of a watch ( perform slowly and without overstretching )

– Repeat the movement in opposite direction.

Exercise 5 :

 

– place several fingers of  hands on each of the temples and then stretch the skin back.

– In this position, open and close the eyes quickly for about  10 to 15 times.

 

THANK YOU

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