PTOSIS

Ptosis - drooping of the eyelid, may be congenital or acquired.

1. Congenital - genetic

Absent or poorly developed superior levator muscle; may be associated
weakness of the superior rectus. Also congenital iii nerve palsy.

2. Acquired

(a) Traumatic - direct muscle involvement.
(b) Inflammation - infections - of the eyelids, the forehead, the eye (intraocular)
or the orbit.
(c) Muscular - myasthenia gravis (tensilon test), myopathies, myotonia.
(d) Senile - myopathy, skin laxity, blepharochalasis.
(e) Neural - lesions of CIII - at the nucleus, in the cranium or in the orbit. Jaw
winking - upper eyelid lifts with chewing ( wrongly directed fibres
of CIII.
Sympathetic Paralysis Muiler's muscles - Horner's Syndrome.
(f) Tumours - neurofibromatosis, pressure on CIII.
(g) Vascular - aneurysms of the intracranial arteries - pressure on CIII.
(h) Functional - associated with photophobia or diplopia, hysterical.

Treatment - medical or surgical depending on the underlying cause. Surgery
by levator shortening or slings to the frontalis muscle.

Unilateral congenital ptosis needs urgent treatment if the pupil is converted,
otherwise severe amblyopia will occur.

Eyelid retration and lid lag
Thyroid eye disease
Overactivity of Muiler's muscle after ptosis operations.