Lagophthalmos

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Lagophthalmos
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Lagophthalmos

• Definition Incomplete closure of the palpabral
  aperture when attempt is made to close the eyes.

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Causes of Lagophthalmos

• Contraction of lids due to cicatrization or a
  congenital deformity
• Ectropion
• Paralysis of Orbicularis
• Proptosis due to exophthalmic goitre, orbital
  tumour/ inflammmation etc.
• Laxity of tissue and absence of reflex blinking
  who are extremely ill.

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Clinical Picture

• Symptoms
• Inability to close eye(s)
• Symptoms of dry eye
• Blurring of vision
• Foreign body sensation
• Photophobia

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Clinical Picture

• Signs
• Incomplete closure of lid
• Exposure of conjunctiva and cornea
• Dryness, congestion
• Hazyness of cornea, punctate infiltration
• Complications
• 1. Corneal ulcer (Non-healing)

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Treatment

• Medical Treatment
• Lubricating Eye drops
• Control of infection
• Protection of ocular surface
• Surgical Treatment
• Tarsorrhaphy (Lateral or paramedian)

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PTOSIS
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Ptosis

• Definition Drooping of upper lid usually due to
  paralysis or defective development of the levator
  palpebrae superioris (LPS)

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Types

• Congenital
• 1. Simple
• 2. Complicated
• Acquired
• 1. Neurogenic
• 2. Myogenic
• 3. Aponeurotic
• 4 Mechanical

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Types

• Pseudoptosis in Phthisis bulbi and anophthalmos
  
• Condition may be Unilateral or Bilateral
• Partial or complete

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Measurement

• Normal position of lids
• Abnormal Margin Reflex Distance (MRD)- Normal
  MRD is 4 mm /- 1 mm
• Ptosis of less than 2 mm Mild
• Ptosis of 3 mm moderate
• Ptosis of 4 mm or more severe

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Compensatory Mechanism

• Overaction of frontalis
• Throwing back the head
• Assessment of LPS function
• Excursion of 8 mm or more good action
• Excursion of 5-7 mm Fair action
• Excursion of 4 mm or less poor
• Look for Bell phenomenon

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Congenital Ptosis

• Commonest form of ptosis
• Usually bilateral / Heriditary
• Due to defective development of LPS
• Simple congenital ptosis is an isolated
  abnormality

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Congenital Ptosis

• Complicated when associated with developmental
  abnormality of surrounding structures
• Associated Sup rectus palsy
• Abnormal synkineses Marcus Gunn ptosis
• Dystrophy of the LPS
• Blepharophimosis syndrome (Ptosis, horizontal
  shortening of palp aperture, epicanthus inversus,
  telecanthus lat ectropion of the lower lids)

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Treatment of Congenital Ptosis

• Age (3-5 years), early surgery when pupil is
  covered
• Fasanella servat operation (indicated when
  ptosis is 1.5 2 mm excision of 4-5 mm upper
  tarsus)
• LPS resection 10 mm resection is minimum
  (resection ranges from 12 24 mm)
• Conjunctival (Blaskovics operation) or skin
  (Everbusch operation) route for surgery

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Treatment of Congenital Ptosis

• Frontalis suspension- intact LPS with poor
  function (3 mm or less)
• 4-0 Supramid suture or fascia lata is used
• Complications associated with this operation

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Acquired Ptosis

• Usually unilateral
• Types
• Neurogenic Third nerve paralysis or due to
  reduced sympathetic innervation (Horner syndrome
  ptosis, anhydrosis and miosis)
• Treatment of cause, crutch spectacle, surgery
  LPS resection/ Frontalis suspension

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Acquired Ptosis

• 2. Myogenic gradual onset, bilateral condition,
  symmetrical
• Myotonic dystrophy
• Chronic progressive exophthalmoplegia
• Mysthenia gravis ( damage to acetyl-cholin
  receptor at postsynaptic membrane with presence
  of antiacetylcholine receptor antibodies)

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Acquired Ptosis

• Mysthenia Gravis-
• Symptoms variable
• Signs bilateral ptosis, increases by prolonged
  fixation or attempt to look up , external
  ophthalmoplegia partial or complete
• Conformation by prostigmin or edrophonium
  injection test

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Acquired Ptosis

• Aponeurotic Ptosis
• Is involutional is due to weakness or
  disinsertion of LPS aponeurosis from ant surface
  of tarsal plate
• High lid fold with good LPS function
• Treatment reinsertion of LPS and resection of
  LPS
• Mechanical Ptosis - Tumour or inflammation
  weigh down the lid

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Contusions

• Black Eye swelling and ecchymosis of lids and
  conjunctiva
• Cryptophthalmos rare condition characterized by
  presence of skin passing continuously from brow
  over the eye to the cheek.