CC March 2016 Ocular Ptosis

echoecho's version from 2016-05-29 16:03


Question Answer
Define blepharoptosis ("ptosis")?low hanging upper lid when the eye is in normal gaze
What causes ptosis?dysfunction of one or both of the upper eyelid elevator muscles, levator palpebrae superioris (a striated muscle) and the Mueller muscle (an involuntary muscle)
Ptosis can be classified as what 2 categories?1) congenital 2) acquired
Compare congenital vs. acquired ocular ptosis?Congenital ptosis occurs in children while acquired ptosis generally is a disease of an older adult.
What is the consequence of uncorrected congenital ptosis?1) obstructed vision 2) amblyopia
Adult ptosis has what s/s?frontal headahces that are tension in nature (they overuse the muscles of the forehead to compensate for the dropping lid)
What 2 conditions can ptosis cause a problem of?1) can be cosmetic problem (making the patient appear sleeping) 2) can impair vision in the upper fields
Is there a gender or race predilection?no
List 4 etiologies of ptosis?1) aponeurotic 2) neurogenic 3) myogenic 4) traumatic/mechanical
What is the most common cause of acquired ptosis, aponeurotic ptosis?1) intrinsic problems with the elevator muscles (involution, dehiscence or disinsertion) 2) chronic inflammation (as a complication of surgery or from long-term use of contact lenses
Regarding neurogenic causes of ptosis, interruption of sympathetic nerve fibers to the elevator muscles produces Horner's syndrome, list the symptoms?1) ptosis 2) miosis 3) hemianhidrosis
Most cases of Horner's syndrome are what? List the less common causes of Horner's sydnrome?1) idiopathic 2) brainstem stroke 2) Pancoast tumors in the apex of the lung 3) trauma 4) dissecting carotid artery aneurysm
Dysfunction of the 3rd cranial nerve may also produce ptosis and may be due to what causes?1) trauma 2) multiple sclerosis 3) vasculopathy 4) infection
Has diabetes been implicated as a neurologic causes of ptosis?yes
Regarding the myogenic causes of ptosis. Does this include congenital ptosis? List the causes of acquired causes of myogenic ptosis?1) yes 2) myastehnia gravis, chronic progressive external opthalmoplegia, oculopharyngeal dystrophy, myotonic dystrophy
Regarding the traumatic / mechanical causes of ptosis, any facial injury results in what damage can disrupt the elevators and produce ptosis? Mechanical distortion due to what 2 conditions similarly can produce ptosis? 1) eyelid laceration 2) tumors or hemangiomas
In addition to a thorough hx, pts w/ ptosis should have a neurological exam to evaluate for systemic neurological diseases, particularly if the ptosis is _____?bilateral
What imaging and procedure may be needed to r/o multiple sclerosis?1) MRI brain 2) spinal fluid analysis
What lab is needed to r/o myasthenia gravis?acetylcholine receptor antibodies
What imaging is needed to r/o possible Horner's syndrome?head, neck and lungs
Ptosis due to an underlying medical conditions improves with treatment of the _____ conditions?causative
*** With appropriate patient selection, ____ repair can provide significant improvement in vision and quality of life?surgical
*** SUMMARY = Ptosis occurs as the results of what?1) dysfunction of one or both of the upper eyelid elevator muscles
*** SUMMARY = Uncorrected congenital ptosis may lead to what?1) obstructed vision 2) amblyopia
*** SUMMARY = Patients with adult ptosis may report what symptoms that are tension in nature, as they overuse the muscles of the forehead to compensate for the dropping lid?frontal headaches