Lagophthalmos: and ptosis

Definition : Incomplete closure of the palpabral aperture when attempt is made to close the eyes

Causes of Lagophthalmos

•Contraction of lids due to cicatrization or a congenital deformity

•Ectropion

•Paralysis of Orbicularis

•Proptosis due to exophthalmic goitre, orbital tumour/ inflammmation etc.

•Laxity of tissue and absence of reflex blinking who are extremely ill.

Clinical Picture

Symptoms:

1.Inability to close eye(s)

2.Symptoms of dry eye

3.Blurring of vision

4.Foreign body sensation

5.Photophobia 

Signs

1.Incomplete closure of lid

2.Exposure of conjunctiva and cornea

3.Dryness, congestion

4.Hazyness of cornea, punctate infiltration

Complications

1. Corneal ulcer (Non-healing)

'� - a (�] x`] bri;font-size:178%'>1.Inability to close eye(s)

2.Symptoms of dry eye

3.Blurring of vision

4.Foreign body sensation

5.Photophobia 

Medical Treatment

1.Lubricating Eye drops

2.Control of infection

3.Protection of ocular surface

Surgical Treatment:

Tarsorrhaphy  (Lateral or paramedian)

. Corneal ulcer (Non-healing)

Ptosis

Definition: Drooping of upper lid usually due to paralysis or defective development of the levator palpebrae superioris (LPS) 

Types

•Congenital

1. Simple

2. Complicated

•Acquired

1. Neurogenic

2. Myogenic

3. Aponeurotic

4 Mechanical

•Pseudoptosis – in Phthisis bulbi and anophthalmos

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•

•Condition may be Unilateral or Bilateral

•Partial or complete

Measurement 

•Normal position of lids

•Abnormal – Margin Reflex Distance (MRD)- Normal MRD is 4 mm +/- 1 mm

•Ptosis of less than 2 mm – Mild

•Ptosis of 3 mm – moderate

•Ptosis of 4 mm or more – severe

Compensatory Mechanism 

•Overaction of frontalis

•Throwing back the head

•

•Assessment of LPS function –

Excursion of 8 mm or more – good action

Excursion of 5-7 mm – Fair action

Excursion of 4 mm or less – poor

•Look for Bell phenomenon 

Congenital Ptosis

•Commonest form of ptosis

•Usually bilateral / Heriditary

•Due to defective development of LPS

•Simple congenital ptosis is an isolated abnormality

•Complicated – when associated with developmental abnormality of surrounding structures

Associated Sup rectus palsy

Abnormal synkineses – Marcus Gunn ptosis

Dystrophy of the LPS  

Blepharophimosis syndrome (Ptosis, horizontal shortening of palp aperture, epicanthus inversus, telecanthus lat ectropion of the lower lids)

Treatment of Congenital Ptosis 

•Age (3-5 years), early surgery when pupil is covered

•Fasanella –servat operation (indicated when ptosis is 1.5 – 2 mm – excision of 4-5 mm upper tarsus)

•LPS resection – 10 mm resection is minimum (resection ranges from 12 – 24 mm)

•Conjunctival (Blaskovics operation) or skin (Everbusch operation) route for surgery

•Frontalis suspension- intact LPS with poor function (3 mm or less)

4-0 Supramid suture or fascia lata is used

Complications associated with this operation

Acquired Ptosis

•Usually unilateral

Types

1.Neurogenic – Third nerve paralysis or due to reduced sympathetic innervation (Horner syndrome – ptosis, anhydrosis and miosis)

Treatment – of cause, crutch spectacle, surgery – LPS resection/ Frontalis suspension

2. Myogenic – gradual onset, bilateral condition, symmetrical

Myotonic dystrophy

Chronic progressive exophthalmoplegia

Mysthenia gravis ( damage to acetyl-cholin receptor at postsynaptic membrane with presence of antiacetylcholine receptor antibodies)

Aponeurotic Ptosis

Is involutional is due to weakness or disinsertion of LPS aponeurosis from ant surface of tarsal plate

High lid fold with good LPS function

Treatment – reinsertion of LPS and resection of LPS

Mechanical  Ptosis - Tumour or inflammation weigh down the lid

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Contusions

Black Eye – swelling and ecchymosis of lids and conjunctiva

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•Cryptophthalmos – rare condition characterized by presence of skin passing continuously from brow over the eye to the cheek.








Vd. Sushant Shashikant Patil
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Faipur425503
tal - yawal
dist- jalgaon
09860431004
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