Steven Leibowitz, MD
  • 100 UCLA Medical Plaza, Suite 747, Los Angeles, California,90024
    310-272-0808
  • 653 Town Center Drive, Suite 102, Las Vegas, Nevada,89144
    702-242-5555
  • 8641 Wilshire Blvd, Suite 312, Beverly Hills, California,90211
    310-272-0808
  • 5301 Truxton Avenue, Suite 200, Bakersfield, California,93309
    661-412-2322
  • 299 N. Pecos Road, Henderson, Nevada,89074
    702-242-5555
Procedures

Evaluation of a Ptosis Patient

Ptosis (from Greek Ptosis or πτ?σις, to "fall") is a (drooping) of the upper or lower eyelid.

Overview

  • The drooping may possibly be worse after being awake longer, when the individual's muscles are tired.
  • This condition is may be called "lazy eye", but that term normally refers to amblyopia.
  • If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism.
  • This is a photograph of a patient with severe bilateral ptosis (Ptosis is sometimes referred to as Blepharoptosis. It refers to an eyelid which is droopy. This may possibly cause a loss of vision, especially while reading, headaches, and eyebrow strain.

When ptosis is asymmetrical (worse on one side) or unilateral, we must consider Hering's law of equal innervation

  • Hering's law of equal innervation proposes that conjugacy of saccades is due to innate connections in which the eye muscles responsible for each eye's movements ar innervated equally.
  • This theory is in contrast to the theory proposed by Von Helmholtz (1911) which states that conjugacy is a learned, coordinated response and that the movements of the eyes are individually controlled.
  • Thus, if we surgical repair (lift) one eyelid, the OTHER eyelid may possibly in fact become droopy.
  • As you slide the control from the left to the right, you will see the 'see-saw' effect of the ptosis as the RIGHT eyelid undergoes simulated elevation, and the left eyelid drops.
Evaluation of patients with moderate (or better levator function) may possibly involve 2.5% phenyelphrine drops to assess the response.

 

 

 

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