Page 205 - Read Online
P. 205
Page 6 of 23 Farber et al. Plast Aesthet Res 2020;7:20 I http://dx.doi.org/10.20517/2347-9264.2020.05
A B
Figure 7. A: congenital ptosis in a child with left ptosis; B: the pathognomonic sign of left lagophthalmos in downgaze to restriction of
the lid from fibrosis of the levator and Mueller’s muscle
A B
Figure 8. A: an elderly woman with bilateral ptosis worse on the left side from dehiscence of the levator aponeurosis; B: on downgaze,
there is no restriction or lagophthalmos
PATIENT EVALUATION
History
As with any preoperative patient evaluation, the assessment must begin with a thorough medical history.
In the case of an adult patient with new onset ptosis presenting for eyelid surgery, special attention must
be paid to risk factors other than aging, including thyroid disease, diabetes, bleeding diatheses, periorbital
surgery or trauma, other ocular conditions, and an orbital or brain tumor, which must be excluded by MRI
or CT scan. These patients should be cleared for ptosis surgery by a neuro-ophthalmologist [Figure 9].
Adult patients who have acute acquired unilateral ptosis without a history of trauma, recent cataract or
vision surgery when a speculum was used, or long-standing history of unilateral contact use should also be
ruled out for development of an intraorbital or intracranial tumor.
