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HWN Suggests

Ocular Ptosis and Its Differential Diagnosis

Acquired ptosis can be caused by a number of etiologies, ranging from those related to normal aging changes to potentially life-threatening conditions. Generally, ptosis can be filed into one of the following categories: aponeurotic, traumatic, mechanical, myogenic, or neurogenic.

Because ptosis can be a harbinger of a possible serious underlying neurologic condition, it is imperative to be able to identify the slightest degree of ptosis, even in an asymptomatic individual, because the magnitude of ptosis does not indicate its etiology.

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  How to Spot and Treat Dangerous Ptosis

The first of a two-part review of the potentially dangerous disease entities that may present with ptosis.

 How to Spot Dangerous Ptosis—The Sequel

Ptosis is a common condition and, fortunately, the majority of etiologies are benign. However, a few history and examination points can rule out dangerous causes of ptosis. The simple mantra of “upper lid, pupils, and EOMs–if one is abnormal check the other two” cannot be overemphasized.

 Self-Resolving Ischemic Third Nerve Palsy

When there is a third nerve palsy without pupil involvement, this is more suggestive of microvascular ischemia, a complication often seen in poorly managed diabetics. Additionally, another important cause of ischemic third nerve palsy is vasculitis, particularly giant cell arteritis.

Articles of Interest

Clinical presentation and management of congenital ptosis

Congenital ptosis is a rare condition characterized by lower positioning of the upper eyelid that is present at birth and is a clinical condition that is persistent if not treated. It may be unilateral or bilateral and may be associated with other ocular disorders or systemic conditions, including Marcus Gunn, Horner, and Duane syndromes. It is a benign condition but causes functional, cosmetic, and psychological problems in children.

Emergency Department Evaluation of Ptosis

Describe the appropriate steps to take in the emergency department when evaluating ptosis of recent onset.

Herpes Zoster Ophthalmicus Complicated by Unilateral Ptosis and Abducens Nerve Palsy: A Case Report

HZO may lead to ophthalmoplegia weeks after the onset of the neurocutaneous symptoms. The most common cause of ophthalmoplegia appears to be oculomotor nerve palsy, which may present as diplopia, mydriasis, and ptosis

Managing a patient with ptosis

Contrary to the commonly held belief of medical students, myasthenia and Horner’s syndrome are not the commonest causes of acquired ptosis. By far, the commonest cause of acquired ptosis is aponeurotic dehiscence – often due to ageing or contact lens wear.

The OD's Guide to Ptosis Workup

Ptosis, formally known as blepharoptosis, is a common finding characterized by upper eyelid drooping in primary gaze. Commonly, ptosis is merely a reality of aging, but some occurrences are related to systemic diseases or genetic disorders.

Visual Dx: Typical Eye Irritation? Don’t Miss This

The patient underwent unremarkable CT angiography with no aneurysm or intracranial etiology found. He was subsequently diagnosed with microvascular diabetic 3rd nerve palsy. The temporal relation of the onset of symptoms to sanding fiberglass was a coincidental red herring.

Resources

Moran CORE

Neurogenic ptosis is a potential emergency, especially when sudden onset. There are two especially concerning neurogenic causes: Horner’s syndrome and a cranial nerve III palsy. Myasthenia gravis is a less common cause of neurogenic ptosis.

Tolosa Hunt Syndrome

Affected individuals may exhibit signs of paralysis (palsy) of certain cranial nerves such as drooping of the upper eyelid (ptosis), double vision (diplopia), large pupil, and facial numbness. The affected eye often abnormally protrudes (proptosis). The exact cause of Tolosa-Hunt syndrome is not known, but the disorder is thought to be associated with inflammation of specific areas behind the eye (cavernous sinus and superior orbital fissure).