Ptosis (F) Flashcards Preview

III. Ocular Neurology > Ptosis (F) > Flashcards

Flashcards in Ptosis (F) Deck (13)
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1
Q

What should be done if there is a ptosis with no pupil abnormality?

A
  1. look for signs of myasthenia gravis

2. If no MG then look for Chronic progressive external ophthalmoplegia (CPEO) or myotonic dystrophy

2
Q

What does ptosis with ipsilateral pupil dilated with decreased reactivity suggest?

A

third nerve palsy

3
Q

What is the management of congenital ptosis?

A

observe unless covers pupil (amblyopia)

4
Q

What is the cause of congenital ptosis? 1. What is a key sign of this? 2

A
  1. failure of LPS to differentiate

2. when look down, eye with ptosis is higher; inadequate Bell’s phenomenon

5
Q

What are the potential cause of ptosis if no pupillary involvement and no MG signs?

A
  1. CPEO
  2. myotonic dystrophy
  3. Fisher’s variant of Guillain-Barre syndrome
  4. Myasthenia gravis with false negative on Tensilon test
  5. cranial nerve involvement, eg. pupil-sparing CN III paresis
6
Q

What are examples of pseudoptosis?

A
  1. blepharospasm
  2. dermatochalasis
  3. retraction of contralateral lid
  4. vertical eye deviation
  5. lack of support from globe (enophthalmos, microophthalmia, phthisis bulbi)
7
Q

What are the signs of Chronic progressive external ophthalmoplegia (CPEO)?

A

bilateral and progressive with EOM involvement

8
Q

What does ptosis with ipsilateral miosis suggest?

A

Horner syndrome

9
Q

What is the ptosis that improves with contraction of masseter muscle called? 1. What is the management? 2

A
  1. Marcus-Gunn or jaw winking phenomenon

2. no neuro eval needed, possibly surgery for ptosis

10
Q

What does ptosis with large pupil with sphincter tears/ruptures observed on biomicroscopy suggest?

A

trauma or surgery

11
Q

How do you determine if a patient has vertical muscle imbalance leading to a pseudoptosis?

A

measure palpebral fissure with each eye fixating (should be equal)

12
Q

What is the most common cause of acquired ptosis? 1. What are the signs? 2

A
  1. aponeurotic (levator dehiscence)

2. high skin crease, deeper superior lid sulcus, ptotic lid lower than normal lid in up and down gaze

13
Q

What are the signs of myotonic dystrophy?

A
  1. christmas tree cataract
  2. inability to release muscles after action (shake hand and difficulty releasing)
  3. family history