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Chapter-16 Repair of Eyelid Ptosis

BOOK TITLE: Sataloff's Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Facial Plastic and Reconstructive Surgery) - Volume 3

Author
1. Kent Tiffany L
2. Holds John B
ISBN
9789351524595
DOI
10.5005/jp/books/12699_17
Edition
1/e
Publishing Year
2016
Pages
12
Author Affiliations
1. Washington University School of Medicine, St. Louis, Missouri, USA
2. St. Louis University School of Medicine, St. Louis, Missouri, USA
Chapter keywords
eyelid ptosis, aponeurotic dehiscence, levator aponeurosis, contact lens, Myopathic ptosis, chronic progressive external ophthalmoplegia, CPEO, myasthenia gravis, congenital ptosis, Horner syndrome, topical cocaine drops, acute-onset third-nerve palsy, diplopia, marginal reflex distance, MRD, frontalis sling, levator function ptosis

Abstract

This chapter discusses repair of eyelid ptosis, where dehiscence of the levator aponeurosis is the most common cause of ptosis. Middle-aged patients, usually with a long history of rigid contact lens use, present with aponeurotic dehiscence and resultant ptosis. A careful physical examination or imaging reveals a mass process as the causative factor in the ptosis. Myopathic ptosis includes chronic progressive external ophthalmoplegia (CPEO), myasthenia gravis (MG) and most cases of congenital ptosis. The diagnosis of Horner syndrome is made after instillation of topical cocaine drops into both eyes. An acute-onset third-nerve palsy will present with ptosis and likely complaints of diplopia. Eyelid retraction, which is most commonly seen in Graves’ disease, can create the appearance of ptosis on the contralateral eye. The degree of ptosis is measured by the marginal reflex distance-1 (MRD-1). Once ptosis is diagnosed and categorized, surgical planning can begin. The frontalis sling is the procedure of choice for those patients with poor levator function ptosis.

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