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Chapter 15
116
Table 15-1
Classification of Ptosis
Levator maldevelopment (dysmyogenic) ptosis
• Simple (defect isolated to levator muscle)
Aponeurotic ptosis (dehisced or disinserted aponeurosis
secondary to the following)
• Age
• With superior rectus muscle weakness
• Cataract or other ocular surgery
• Blepharophimosis syndrome
• Congenital fibrosis of the extraocular muscles
Myogenic (myopathic) ptosis
• Oculopharyngeal dystrophy
• Chronic progressive external ophthalmoplegia
• Muscular dystrophy
• Myasthenia gravis
• Trauma to the muscular levator
Neurogenic ptosis
• Local blunt trauma
• Blepharochalasis
• Chronic edema (Graves’ disease, allergy, etc)
Mechanical ptosis
• Excess lid weight (lid or orbital mass)
• Scarring
Pseudoptosis
• Due to lack of posterior eyelid support
• Due to hypotropia
• Oculomotor nerve palsy (third nerve)
• Due to dermatochalasis
• Misdirected oculomotor nerve regeneration
• Due to globe malposition
• Marcus-Gunn jaw-winking ptosis
• Horner’s syndrome
• Ophthalmoplegic migraine
Adapted from Rathbun JE. Eyelid Surgery. Boston, MA: Little, Brown; 1990:203.
Table 15-2
Table 15-3
Amount of Ptosis
Amount of
Ptosis (mm)
<2
Levator Muscle Function
Classification
Levator Muscle
Function (mm)
Classification
Mild
15
Normal
3
Moderate
>8
Good
>4
Severe
5 to 7
Fair
<4
Poor
Surgical Procedure
Step 1
Step 4
After sterile skin preparation and sterile draping,
upper eyelid just above the lash line, and the lid
is placed on traction. This is done after the eyelid
incision is carried to the tarsus so as to not distort
the various layers of the anterior lamella.
the upper eyelid crease is marked at the desired
height so as to be symmetric with the opposite
upper eyelid crease.
Step 5
Step 2
Local anesthesia is injected subcutaneously along
Step 3
Step 6
The skin is incised along the marked eyelid crease
with a blade. The incision is made deeper through
the orbicularis muscle to expose the superior border of the tarsus from medial to lateral with scissors
(Figure 15-1).
The orbicularis muscle is dissected inferiorly 3 to
4 mm to expose the superior tarsus and approximately 10 mm superiorly to expose the levator aponeurosis and the orbital septum.
the eyelid crease and subconjunctivally along the
superior border of the tarsus.
A 4-0 silk traction suture is placed centrally in the
At the medial and lateral ends of the tarsus, scissor
incisions are made through the remaining eyelid at
the edge of the tarsal border (Figure 15-2).