Physical Examination: eyelid margin position
Physical examination: Degree of ptosis Levator function
Ocular motility
Factors that change lid position Associated lid anomalies
Physical examination:
High Lid crease, Good levator function History: onset, Variability, trauma
Patient with DROOPY EYELID Pseudoptosis
No Lid Edema Consider:
Dermatochala sis, Motility disorder, Blepharospas
m (p 126), Microphtalmia
True Ptosis Congenital
Variability of ptosis or systemic weakness Tensilon test Negative
Simple Congenital
ptosis
Positive Neonatal myasthenia
gravis
Ocular elevation palsy
Congenital ptosis with elevation palsy
Jaw wink Synkinetic
ptosis
Associated syndrome
Syndromic ptosis
Acquired Pupil abnormal
Consider:
Acquired neurogenic
ptosis Anisocoria present
Miosis Horner's
Syndrome Mydriasis Assess ocular
motor dysfunction
consider:
Aneurysm, Neoplasm, Neurologic disorder CT Scan neurologic evaluation
No Anisocoria present gastrointestinal No
symptoms Consider:
Polyneurop athy Neurologic
evaluation
Gastrointestinal Symptoms
Present impaired accomodati
on Consider:
botulism
Pupil Normal History of trauma
Traumati c ptosis
No History of trauma Associated lid
deformity Acquired mechanical
ptosis consider: Lid
tumor, Blepharochala
sis
No Lid deformity Ocular motility
disturbance, Variability of ptosis
Consider:
Acquired myogenic ptosis
Tensilon test Positive
Myasthenia gravis Neurologic
evaluation
Negative Associated
neuro- ophtalmic signs
Consider:
CPEO,Guillain- Barre syndrome,
Muscular dystrophy, Oculopharyngeal
dystrophy
Associated No neuro- Ophtalmic
signs Acquired aponeurotic
ptosis No Ocular motility
disturbance, No variability of
ptosis
