BLEPHAROPTOSIS

Definition. Ptosis may be divided into two types :

1. Pseudoptosis

2. True ptosis

   • Acquired

   • Congenital

   • Hereditary

Etiology

1. Acquired ptosis

   • Acute or subacute diseases

   • Intoxications

   • Syphilis

   • Lesions of the brain

   • Other causes

2. Congenital ptosis

   • Abnormal development of the levator muscle

   • Failure of the nucleus of the third nerve

   • Evidence to support either theory is to be found in

     • Postmortem examination

     • Biopsies

     • Operative observations

     • Comparative anatomy

     • Embryology

3. Hereditary ptosis

Incidence

1. Of operations for ptosis

2. Of types of operation

Clinical Anomalies Associated with Ptosis

1. Abnormal extraocular motility

   • Weakness of the superior rectus and/or the inferior oblique muscle

   • Exotropia

   • Esotropia

   • External ophthalmoplegia

   • Duane's retraction syndrome

2. Abnormal development of the lids

   • Epicanthus

     • Superciliary type

     • Palpebral type

     • Tarsal type

   • Blepharophimosis

   • Abnormal inner canthus

3. Abnormal innervation of levator, producing jaw-winking (Marcus Gunn phenomenon)

4. Other abnormal developmental defects

Preoperative Study of Ptosis Should Include

1. Measurement of ptosis

2. Determination of function of levator

3. Cocaine test

4. Extraocular motility