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Most important part of ptosis treatment is the preoperative exam
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WAILEA, Hawaii — Investigate the patient history and review patient treatment goals and expectations, when evaluating a patient for ptosis, Femida Kherani, MD, FRCSC, said at Hawaiian Eye 2018.
Kherani categorized the types of ptosis noting that ptosis can be classified as congenital and acquired.
Further subclassifications include: involutional due to aging, myogenic, neurogenic (that is, anything affecting the third nerve or Horner’s syndrome), mechanical (caused by a mass) and pseudoptosis (seen in patients with prosthetic eyes).
Ptosis may cause astigmatism or amblyopia and can be considered simple, isolated or part of a syndrome, like blepharophimosis eyelid syndrome, Kherani said.
Ptosis affects children more often unilaterally at a rate of 3:1, and with a force that is relevant to the child’s visual development
A thorough preoperative evaluation is essential to identify patient goals and expectations, she said.
“I find more and more that ptosis is becoming an aesthetic surgery,” Kherani said. “Patients are expecting aesthetic results from this functional surgery.”
During the important preoperative exam, she recommends identifying patient goals and expectations; determining when the ptosis started, and if there is any variability, muscle weakness, or dysstasia. She also checks for diplopia and Horner’s syndrome.
“I like to identify head position, to determine if patients are adjusting to compensate for their ptosis,” Kherani added.
She also likes to rule out body dysmorphic disorder during preoperative examination. “Up to 1% of adult population has the disorder. I think that Facebook and Twitter make these things worse as everyone is taking a lot of photos and expecting their eyes to be symmetric at all angles,” she said.
She also always checks for dryness. “If they have pre-existing dry eye, even if they aren’t symptomatic, a higher eye is a dryer eye, so it’s very important to check,” Kherani said. – by Abigail Sutton
Reference:
Kherani F. Beyond bedroom eyes: Evaluation and management of ptosis. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.
Disclosure: Kherani is a speaker for Allergan, Mertz and Novartis.