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Eyelids
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Omar Kouli, Mostafa Khalil, Stewart Gillan
Ptosis refers to the drooping of the upper eyelid. There are various causes, such as neurogenic (e.g. Horner syndrome, CNIII palsy), myogenic (e.g. myasthenia gravis, myotonic dystrophy), involutional (age-related) or congenital (due to failure of development of the levator muscle).
Diagnosis and Differential Diagnosis
Published in Marc H. De Baets, Hans J.G.H. Oosterhuis, Myasthenia Gravis, 2019
Ptosis131 is diagnosed if the upper-eyelid covers more than 2 mm of the cornea and is caused by a weakness of the m. levator palpebrae or the m. tarsalis superior. If no muscle weakness is involved, but an anatomical variation, either physiologic or pathologic, (e.g., after orbital trauma, aberrant regeneration after facial nerve affection) the condition is referred to as pseudoptosis. If both upper-eyelids are “drooping” symmetrically it is not always easy to determine whether this is due to muscle paresis. Especially in older people without complaints, the most obvious cause is a displacement of the eyeballs due to the lack of fat tissue. Central innervation may also be deficient in intoxications with sedatives, or in acute large hemispheric lesions, especially of the nondominant side.132
Impairment of functions of the nervous system
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Ptosis refers to dropping of the upper eyelid 1.5–2.0 mm below the upper limbus. The ptosis may be due to slippage of the aponeurosis; impairment of muscle function viz., levator palpebrae superioris in myasthenia gravis, muscular dystrophy, myopathy, and so on; neurogenic lesion in oculomotor nerve or sympathetic nerve; prolapse of the orbital fat, tumor of the eyelid; traumatic disinsertion of the levator palpebrae superioris. Integrated Evaluation of Disability defines impairment of ptosis based on margin reflex distance (18) (Table 6.8). Integrated Evaluation of Disabilityassigns impairment only when medical/surgical management does not restore the function.
Upper blepharoplasty: advanced techniques and adjunctive procedures
Published in Expert Review of Ophthalmology, 2023
Parya Abdolalizadeh, Mohsen Bahmani Kashkouli, Vahid Khamesi, Nasser Karimi, Hossein Ghahvehchian, Leila Ghiasian
Eyelash position and angle should be assessed in cases of upper eyelid blepharoplasty, preoperatively. In fact, an upward tilt of the eyelashes is considered esthetically pleasing. The eyelash initially points slightly downward as it emerges from the anterior lamella of the eyelid margin and then curves upward [100]. The angle and upward bending of the lashes are greater in Caucasian subjects as compared with Asians [100,101]. Eyelash ptosis refers to straight or downward projection of the eyelash follicles and may coincide with dermatochalasis. Decreased levator function in congenital blepharoptosis, aponeurotic blepharoptosis, cicatricial entropion, and floppy eyelid syndrome can also cause misdirection of eyelashes [100–102]. In severe cases, lash ptosis potentially blocks the visual axis or comes in contact with the ocular surface.
Single-stage repair of large full thickness lower eyelid defects using free tarsoconjunctival graft and transposition flap: experience and outcomes
Published in Orbit, 2022
Chau M. Pham, Kevin D. Heinze, Mariah Mendes-Rufino-Uehara, Pete Setabutr
Average patient follow-up time was 36.7 weeks (range 3–129, SD = 48.1). Flap complications were rare and included early necrosis in one patient in whom bolsters were used which resolved without issue. One patient experienced lower lid retraction post-operatively with 1.5 mm of lagophthalmos, while the others maintained good lid position and contour. Donor site complications were also rare and included one instance of pyogenic granuloma formation at post-operative month 3 which was excised. Mild asymmetry in upper eyelid appearance caused by a deepening of the sulcus or elevation of the ipsilateral eyelid crease was noted in most cases. Although blepharoplasty on the contralateral upper eyelid was offered, all patients were satisfied with their appearance and deferred further surgery.
Advancements in the repair of large upper eyelid defects: A 10-year review
Published in Orbit, 2021
Erin Jennings, Mark Krakauer, William R. Nunery, Vinay Kumar Aakalu
Sa et al. conducted a retrospective case series of 17 patients (age range 40–81, 1:7 male to female ratio) with full-thickness upper eyelid defects involving 80% or more of the upper lid margin following tumor excision.8 The authors described two novel modifications to the reverse modified Hughes procedure. First, they mobilize and advance orbicularis oculi muscle superior to the defect to cover the tarsoconjunctival flap. They posit that mobilization reduces scarring, enhances eyelid mobility, and preserves orbicularis functionality in the upper lid. Second, they use adjacent residual skin as an advancement flap to cover the orbicularis flap, as opposed to the traditional skin graft (Figure 1D). Post-operative complications included epithelial keratopathy (23.5%), lagophthalmos (17.6%), upper eyelid entropion (11.7%), granuloma formation (11.7%), and lower eyelid entropion (5.9%). Five patients required secondary procedures. Ultimately, functional and aesthetic outcomes were determined to be satisfactory for all patients within the follow-up period of 6–84 months.