Algorithm of objective examination of a patient with blepharoptosis

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Abstract

Meticulous objective examination of a patient with blepharoptosis allows determining the tactics of surgical treatment. It depends on many factors, but main ones are blepharoptosis etiology, upper eyelid’s levator function, and ptosis degree. The estimation algorithm of objective examination of a patient with blepharoptosis is presented in this article.

About the authors

Vitaly V. Potyomkin

Pavlov First Saint Petersburg State Medical University; City Multi-Field Hospital No. 2

Email: potem@inbox.ru

PhD, Assistant Professor. Department of Ophthalmology; ophthalmologist

Russian Federation, Saint Petersburg

Elena V. Goltsman

City Multi-Field Hospital No. 2

Author for correspondence.
Email: ageeva_elena@inbox.ru

Ophthalmologist

Russian Federation, Saint Petersburg

References

  1. Груша Я.О., Фисенко Н.В., Блинова И.В. Блефароптоз: диагностические тесты // Вестник офтальмологии. – 2016. – Т. 132. – № 3. – С. 61–65. [Grusha YO, Fisenko NV, Blinova IV. Blepharoptosis: diagnostic tests. Annals of ophthalmology. 2016;132(3):61-65. (In Russ.)]. https://doi.org/10.17116/oftalma2016132361-65.
  2. Катаев М.Г., Оруджов Н.З. Новый комбинированный способ хирургического лечения блефароптоза тяжёлой степени: метод подвешивания к брови и к связке Уитналла // Российская педиатрическая офтальмология. – 2009. – № 2. – С. 22–25. [Katayev MG, Orudzhov NZ. New combined method of surgical treatment for severe blepharoptosis: method of suspension to the brow and Whittles ligament. Russian pediatric ophthalmology. 2009;(2):22-25. (In Russ.)]
  3. Катаев М.Г. Современный дифференцированный подход к хирургическому лечению птоза верхнего века // Восток – Запад. Точка зрения. – 2014. – № 1. – С. 258–259. [Kataev MG. Sovremennyy differentsirovannyy podkhod k khirurgicheskomu lecheniyu ptoza verkhnego veka. Vostok–Zapad. Tochka zreniya. 2014;(1):258-259. (In Russ.)]
  4. Bullock JD, Warwar RE, Bienenfeld DG, et al. Psychosocial implications of blepharoptosis and dermatochalasis. Trans Am Ophthalmol Soc. 2001;99:65-71.
  5. Doucet TW, Crawford JS. The quantification, natural course, and surgical results in 57 eyes with Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. 1981;92(5):702-707. https://doi.org/10.1016/S0002-9394(14)74665-3.
  6. Dortzbach RK, Kronish JW. Early revision in the office for adults after unsatisfactory blepharoptosis correction. Am J Ophthalmol. 1993;115(1):68-75. https://doi.org/10.1016/S0002-9394(14)73527-5.
  7. Dadapeer K. Clinical Methods in Ophthalmology: Practical Manual for Undergraduates. New Delhi: JP Medical Ltd; 2013.
  8. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin North Am. 2005;38(5):921-946. https://doi.org/10.1016/j.otc.2005.08.012.
  9. Jordan DR, Anderson RL. Obtaining fascia lata. Arch Ophthalmol. 1987;105(8):1139-1140. https://doi.org/10.1001/archopht.1987.01060080141046.
  10. Lemke BN, Stasior OG, Rosenberg PN. The surgical relations of the levator palpebrae superioris muscle. Ophthalmic Plast Reconstr Surg. 1988;4(1):25-30.
  11. Lyon DB, Gonnering RS, Dortzbach RK, Lemke BN. Unilateral ptosis and eye dominance. Ophthalmic Plast Reconstr Surg. 1993;9(4):237-40. https://doi.org/10.1097/00002341-199312000-00002.
  12. Lucarelli MJ, Lemke BN. Small incision external levator repair: technique and early results. Am J Ophthalmol. 1999;127(6):637-644. https://doi.org/10.1016/s0002-9394(99)00064-1.
  13. Mauriello JA, Jr., Abdelsalam A. Modified levator aponeurotic advancement with delayed postoperative office revision. Ophthalmic Plast Reconstr Surg. 1998;14(4):266-270. https://doi.org/10.1097/00002341-199807000-00008.
  14. Meyer DR, Stern JH, Jarvis JM, Lininger LL. Evaluating the visual field effects of blepharoptosis using automated static perimetry. Ophthalmology. 1993;100(5):651-658. https://doi.org/10.1016/s0161-6420(93)31593-9.
  15. Meltzer MA, Elahi E, Taupeka P, Flores E. A simplified technique of ptosis repair using a single adjustable suture. Ophthalmology. 2001;108(10):1889-1892. https://doi.org/10.1016/s0161-6420(01)00712-6.
  16. McCulley TJ, Kersten RC, Kulwin DR, Feuer WJ. Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis. Ophthalmic Plast Reconstr Surg. 2003;19(5):388-393. https://doi.org/10.1097/01.IOP.0000087071.78407.9A.
  17. Evaluation and treatment of the patient with ptosis. In: Nerad JA. Oculoplastic surgery: the requisites in ophthalmology. Maryland Heights: Mosby Inc.; 2001. P. 120-179.
  18. Putman JR, Nunery WR, Tanenbaum M, et al. Blepharoptosis. In: Oculoplastic surgery. Ed. by C.D. McCord Jr, M. Tanenbaum, W.R. Nunery. New York: Raven Press; 1985. P. 175-220.
  19. Perry JD, Kadakia A, Foster JA. A new algorithm for ptosis repair using conjunctival Mullerectomy with or without tarsectomy. Ophthalmic Plast Reconstr Surg. 2002;18(6):426-429. https://doi.org/10.1097/01.IOP.0000031377.94420.2D.
  20. Renowden SA, Harris KM, Hourihan MD. Isolated atraumatic third nerve palsy: clinical features and imaging techniques. Br J Radiol. 1993;66(792):1111-1117. https://doi.org/10.1259/0007-1285-66-792-1111.
  21. Riemann CD, Hanson S, Foster JA. A comparison of manual kinetic and automated static perimetry in obtaining ptosis fields. Arch Ophthalmol. 2000;118(1):65-69. https://doi.org/10.1001/archopht.118.1.65.
  22. Shao W, Byrne P, Harrison A, et al. Persistent blurred vision after blepharoplasty and ptosis repair. Arch Facial Plast Surg. 2004;6(3):155-157. https://doi.org/10.1001/archfaci.6.3.155.
  23. Schaefer AJ, Schaefer DP. Classification and correction of ptosis. In: Surgery of the eyelid, orbit, and lacrimal system. Ed. by W.B. Stewart. San Francisco: American Academy of Ophthalmology; 1994. P. 84-133.
  24. Whitehouse GM, Grigg JR, Martin FJ. Congenital ptosis: results of surgical management. Aust N Z J Ophthalmol. 1995;23(4):309-314. https://doi.org/10.1111/j.1442-9071.1995.tb00181.x.
  25. Wolfort FG, Poblete JV. Ptosis after blepharoplasty. Ann Plast Surg. 1995;34(3):264-266. https://doi.org/10.1097/00000637-199503000-00007.
  26. Weinberg DA, Lesser RL, Vollmer TL. Ocular myasthenia: a protean disorder. Surv Ophthalmol. 1994;39(3):169-210. https://doi.org/10.1016/0039-6257(94)90194-5.
  27. Wulc AE. Oculoplastic surgery. An overview. J Dermatol Surg Oncol. 1992;18(12):1033-1038. https://doi.org/10.1111/j.1524-4725.1992.tb02780.x.
  28. Ophthalmology. Ed. by M. Yanoff, J.S. Duker. London: Mosby; 1999.

Supplementary files

Supplementary Files
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2. Fig. 1. Ptosis degree estimation (adapted from Collin J.R.O., 2006)

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3. Fig. 2. MRD1 and MRD2 measurement (adapted from Collin J.R.O., 2006)

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4. Fig. 3. Measurement of upper eyelid’s levator function (adapted from Collin J.R.O., 2006)

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5. Fig. 4. Measurement of distance between the margin and the crease (adapted from Collin J.R.O., 2006)

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6. Fig. 5. Types of upper eyelid creases (a — 1st degree, b — 2nd degree, c — 3rd degree, d — 4th degree)

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7. Fig. 6. Measurement of palpebral fissure height (adapted from Collin J.R.O., 2006)

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8. Fig. 7. Aponeurotic ptosis, more pronounced in downgaze (а); Myogenic ptosis, retraction in downgaze (b)

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9. Fig. 8. Mild ptosis before (a) and after (b) phenylephrine instillation

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10. Fig. 9. Poor Bell’s phenomenon

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11. Fig. 10. Illustration of Hering’s law

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12. Fig. 11. Aponeurotic ptosis

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13. Fig. 12. Neurogenic ptosis: a — in a patient with myasthenia gravis; b — in a patient with Horner’s syndrome

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14. Fig. 13. Ptosis in a patient with 3rd cranial nerve palsy

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15. Fig. 14. Marcus Gunn Jaw winking phenomenon

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16. Fig. 15. Different types of mechanical ptosis

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Copyright (c) 2019 Potyomkin V.V., Goltsman E.V.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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