STUDY - Technical - New Dacian's Medicine
Ptosis
(Classical / Allopathic Medicine)
Ptosis
is the excessive drooping of one or both upper eyelids.
This sign can be constant, progressive, or intermittent as
well as unilateral or bilateral. When it's unilateral,
it's easy to detect by comparing the eyelids’ relative
positions. When it's bilateral or mild, it's difficult to
detect - the eyelids may be abnormally low, covering the
upper part of the iris or even part of the pupil instead
of overlapping the iris slightly. Other clues include a
furrowed forehead or a tipped-back head - signs that the
patient is compensating to see under his drooping lids.
With severe ptosis, the patient may not be able to raise
his eyelids voluntarily. Because ptosis can resemble
enophthalmos, exophthalmometry may be required.
Ptosis
can be classified as congenital or acquired.
Classification is important for proper treatment.
Congenital ptosis results from levator muscle
underdevelopment or a disorder of the third cranial
(oculomotor) nerve. Acquired ptosis may result from trauma
to or inflammation of these muscles and nerves, use of a
particular drug, a systemic disease, an intracranial
lesion, or a life-threatening aneurysm. However, the most
common cause is advanced age, which reduces muscle
elasticity and produces senile ptosis.
HISTORY:
Ask the patient when he first noticed his drooping eyelid and whether it has worsened or improved.
Ask the patient if he has recently suffered a traumatic eye injury.
Ask the patient if he has experienced eye pain or headache, and determine its location and severity.
Ask the patient if he has experienced vision changes. If so, have him describe the changes.
Ask the patient if he wears corrective lenses or contact lenses.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, noting especially chemotherapeutic agents. Also, ask the patient about alcohol intake.
Ask the patient when he first noticed his drooping eyelid and whether it has worsened or improved.
Ask the patient if he has recently suffered a traumatic eye injury.
Ask the patient if he has experienced eye pain or headache, and determine its location and severity.
Ask the patient if he has experienced vision changes. If so, have him describe the changes.
Ask the patient if he wears corrective lenses or contact lenses.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, noting especially chemotherapeutic agents. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Assess the degree of ptosis, and check for eyelid edema, exophthalmos, deviation, and conjunctival injection.
Evaluate extraocular muscle function by testing the six cardinal fields of gaze.
Carefully examine the pupil's size, color, shape, and reaction to light, and test visual acuity. Is convergence, photosensitivity, or photophobia present?
Assess the degree of ptosis, and check for eyelid edema, exophthalmos, deviation, and conjunctival injection.
Evaluate extraocular muscle function by testing the six cardinal fields of gaze.
Carefully examine the pupil's size, color, shape, and reaction to light, and test visual acuity. Is convergence, photosensitivity, or photophobia present?
SPECIAL
CONSIDERATIONS:
Keep in mind that ptosis occasionally indicates a life-threatening condition. For example, sudden unilateral ptosis can herald a cerebral aneurysm.
Keep in mind that ptosis occasionally indicates a life-threatening condition. For example, sudden unilateral ptosis can herald a cerebral aneurysm.
PEDIATRIC
POINTERS:
Astigmatism and myopia may be associated with childhood ptosis.
Parents typically discover congenital ptosis when their child is an infant. Usually, the ptosis is unilateral, constant, and accompanied by lagophthalmos, which causes the infant to sleep with his eyes open. If this occurs, teach proper eye care to prevent drying.
Astigmatism and myopia may be associated with childhood ptosis.
Parents typically discover congenital ptosis when their child is an infant. Usually, the ptosis is unilateral, constant, and accompanied by lagophthalmos, which causes the infant to sleep with his eyes open. If this occurs, teach proper eye care to prevent drying.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include the Tensilon test and slit-lamp examination.
Instruct the patient on what to expect from diagnostic testing, which may include the Tensilon test and slit-lamp examination.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.