A 3 year old child is presenting with drooping of upper lid since bih. On examination , the palpebral apeure height is 6 mm and with poor levator palpebrae superioris function. What is the procedure recommended
Ptosis: - * Ptosis or blepharoptosis ( Greek - to fall ) is the drooping of the upper eyelid to a level that covers more than 2mm of the superior cornea. Classification:- Congenital:- * Simple * Associated with Superior Rectus weakness * Associated with Marcus Gun Jaw Winking phenomenon Acquired:- * Neurogenic - III Cn palsy , Horner's syndrome * Myogenic - myasthenia gravis, ocular myopathy, senile * Mechanical - excess weight due to edema, tumors * Traumatic - trauma to levator palpebrae Management :- TREAT the systemic cause Mild Ptosis:- * Mullerectomy --> Muller muscle resection for 1mm ptosis ( HORNER'S SYNDROME) * Fasanella Servat operation -->simple tarsoconjunctival resection Moderate Ptosis:- * With fair - good levator function --> LEVATOR RESECTION Severe Ptosis with Poor Lps Function:- * BROW SUSPENSION / FRONTALIS SLING SURGERY where Lids are attached to the frontalis muscle with a silicon tube. So with the contraction of frontalis , lids elevate. Ref:- A K Khurana Comprehensive Ophthalmology 7th edition; pg num:- 395
Frontalis Sling surgery
Mullerectomy
Fasanella Servat operation
Observation
Diseases of orbit, Lids and lacrimal apparatus