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Evaluation of a Ptosis Patient

Ptosis (from Greek Ptosis or πτ?σις, to "fall") is a (drooping) of the upper or lower eyelid.

Photograph showing a person with bilateral ptosis, drooping eyelids affecting both eyes.

Overview

  • The drooping may possibly be worse after being awake longer, when the individual's muscles are tired.
  • This condition is may be called "lazy eye", but that term normally refers to amblyopia.
  • If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism.
  • This is a photograph of a patient with severe bilateral ptosis (Ptosis is sometimes referred to as Blepharoptosis. It refers to an eyelid which is droopy. This may possibly cause a loss of vision, especially while reading, headaches, and eyebrow strain.

Evaluation of patients with moderate (or better levator function) may possibly involve 2.5% phenyelphrine drops to assess the response.

Image of eye drop bottle with text 'Neo' on the label.

When ptosis is asymmetrical (worse on one side) or unilateral, we must consider Hering's law of equal innervation

  • Hering's law of equal innervation proposes that conjugacy of saccades is due to innate connections in which the eye muscles responsible for each eye's movements ar innervated equally.
  • This theory is in contrast to the theory proposed by Von Helmholtz (1911) which states that conjugacy is a learned, coordinated response and that the movements of the eyes are individually controlled.
  • Thus, if we surgical repair (pull up) one eyelid, the OTHER eyelid may possibly in fact become droopy.
  • As you slide the control from the left to the right, you will see the 'see-saw' effect of the ptosis as the RIGHT eyelid undergoes simulated elevation, and the left eyelid drops.

Herrings Law

 

 

 

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