What’s the diagnosis and treatment of this case in the picture?
It’s a case of severe ptosis and treatment is Hess operation.

So, what is ptosis?
It is dropping of upper eyelid which is normally cover upper 1/6 of cornea
Maybe myogenic as in
1-congenital atrophy of levator palpebrae superioris muscle
2-myasthenia gravis
Maybe neurogenic as in
1-third cranial nerve palsy
2-Horner’s syndrome which affects muller’s muscle and causes partial ptosis
Maybe mechanical as in
1-chalazion in upper eyelid which discusses it before
2-conjunctival fibrosis which Will be discussed later
Maybe due to snile weakness in levator palpebrae superioris muscle

Clinical picture and diagnosis
dropping of the upper eyelid
elevated chin
Arching of brow
You should to know degree of ptosis by measuring marginal reflex distance which is normally 4-4.5mm
You should know levator function by excurtion test (movement of eye from down gaze to up gaze) which is good at 12mm or more
May be associated with one or more of the following signs
Marcus gun phenomenon
Limitation of ocular motility
Bell’s phenomenon

Lumbar lordosis
Contracture of sternomastoid muscle

You should be referred to ophthalmologist because treatment is surgical by one of these surgeries
Levator tuckling
Frontalis sling (Hess operation)
This determined by the degree of ptosis and levator function. And associated signs..

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Category | Ophthalmology
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