| PTOSIS |
| Ptosis is defined as drooping of the upper lid below its normal position. It is the result of the poor development or weakness or paralysis of levator or muller’s muscle (the muscle which elevates the upper eye lid). The ptosis could be by birth (congenital) or develops after birth (acquired). The majority of the cases are congenital. |
| UP |
| Functions of lid |
- Reflex closure of the eye - protects the eye ball (loud noise, glare, flying foreign object)
- Keeps the cornea wet and moist (prevents cornea from dryness).
- Warms by blinking several times.
- Cilia mainly of upper lid protect the eye from flying objects.
Anything that disturbs the upper lid anatomy and physiology becomes not only a cosmetic blemish, but a serious physiologic impediment requiring correction. The upper lid includes the following structures: - |
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Skin
Subcutaneous tissue.
Orbicularis Muscle
Orbital Septum
Anterior extension of orbital fat.
Levator aponeurosis (This is at fault).
Muller muscle.
Tarsoconjunctiva. |
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| Preoperative Examination of ptosis patients - |
| This is the most important step in the treatment of ptosis. The choice of surgery and degree of correction to be carried out at time of surgery depend on this. |
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| History |
- Age of onset
- Improvement / Worsening
- Trauma / birth injury
- Family history
- Previous surgery |
| UP |
| Examination |
- Bilaterality (Involvement of both eyes)
- Degree of ptosis
The width of the palpebral aperture (the distance between the upper lid and lower lid) is measured to quantify the amount of ptosis. The amount of drooping of the upper lid is also a guide to the surgery required.
- Mild ptosis 2mm or less
- Moderate ptosis of3mm
Severe ptosis of 4mm or more.
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| UP |
| LPS action (levator palpebrae superioris) |
| This is the muscle which elevates the upper eye lid. Its action is defined as the excursion of upper lid. The palpebral aperture width is measured as : |
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Normal
Good
Moderate
Poor
No action |
- 15mm or >
- > 8mm
- 5-7mm
- < 4mm
- < 2mm |
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| Surgery |
It is done to elevate the upper eye in relation to the normal eye lid.
Broadly it is divided into two categories.
LPS resection – shortening of the LPS muscle to elevate the eye lid.
Sling – in cases of poor LPS action special material is used to elevate the eye lid.
In complicated cases many other procedures are done, when associated abnormalities are present. |
| Post-Operative care : |
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Patient is kept on antibiotics and anti-inflammatory drugs.
Local hot fomentation for one week.
Cornea is kept moist with lubricant and antibiotics ointment.
Frost suture may be kept for 3-4 days depending on circumstances.
Maintain cleanliness, by keeping the wound clean.
Removal of suture after 1-2 weeks.
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| Before Surgery |
5th Day Post-Operative |
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