• Home
  • Free Medical Videos
  • Online Pharmacy
  • Ophthalmology
  • Gynecology and Obstetrics
Friday, July 18, 2025
  • Login
Meduweb
  • Home
  • Free Medical Videos
  • Online Pharmacy
  • Ophthalmology
  • Gynecology and Obstetrics
No Result
View All Result
  • Home
  • Free Medical Videos
  • Online Pharmacy
  • Ophthalmology
  • Gynecology and Obstetrics
No Result
View All Result
Meduweb
No Result
View All Result
Home Ophthalmology

Clinical Hints for Your clinical stepwise approach for examining the lids (with particular regard to ptosis)

Dr.Reda Gomah El Garia by Dr.Reda Gomah El Garia
September 3, 2018
in Ophthalmology
631 6
0
examining the lids

examining the lids

411
SHARES
671
VIEWS
Share on FacebookShare on Twitter
Contents hide
1 ✍ Observe
2 ✍ measure levator function
3 ✍ measure any lagophthalmos
4 ✍ Assess orbicularis function and Bell’s phenomenon
5 ✍ Assess fatiguability over 1 min for worsening of ptosis
6 ✍ examine for Cogan’s twitch Any overshoot
7 ✍ Assess for jaw-winking For any change in ptosis
8 ✍ examine ocular motility for
9 ✍ examine pupils for
10 ✍ full cranial nerves assessment
11 ✍ exclude pseudoptosis
12 Ptosis Management
13 Ptosis Normal lid measurements gift
13.1 ✍ Palpebral aperture
13.2 ✍ Upper margin reflex distance
13.3 ✍ Upper lid excursion (levator function)
13.4 ✍ Upper lid crease position
14 DD of acute dangerous ptosis

 

✍Shake hands to exclude myotonia (note slow release of grip)

✍ Observe

☝ Face for asymmetry

☝ Brow for overactive forntalis

☝ Globes for position and asymmetry

☝ Lids for position,asymmetry or scars

☝ Pupils anisocoria or heterochromia

✍ measure palpebral aperture

✍ measure upper margin reflex distance

✍ measure position of upper lid crease

✍ measure levator function

☝ Inhibit frontalis by placing a thumb on the brow

✍ measure any lagophthalmos

☝ Ask patient to close eyes, gently at first, and then to squeeze eyes shut

✍ Assess orbicularis function and Bell’s phenomenon

☝ Try to open patient’s eyes against resistance

✍ Assess fatiguability over 1 min for worsening of ptosis

☝Ask patient to keep looking upward at a target held superiorly

✍ examine for Cogan’s twitch Any overshoot

☝ Ask patient to look rapidly from downgaze to a target held in 1ry position

✍ Assess for jaw-winking For any change in ptosis

☝ Ask patient to simulate chewing and to move jaw from side to side

☝ Slitlamp examination of lid and subtarsal
conjunctiva for Inflammation,masses or scars

☝ Check corneal sensation and Bell’s phenomena (very Prognostic for any lid surgery)

✍ examine ocular motility for

☝motility abnormality in 9 cardinal positions

☝ change in ptosis with ocular motility

✍ examine pupils for

☝Anisocoria (in response to light and near)

☝ reactivity

☝ iris heterochromia

✍ Consider ice-pack test for suspected MG

✍ full cranial nerves assessment

☝ ( 2nd , 3rd ,4th ,5th ,6th and 7th )

✍ examination of fundus

✍ systemic review (myopathy, fatiguability).

✍ exclude pseudoptosis

☝Excessive skin ( dermato- or blepharochalasis )

☝ Inadequate globe size( micropthalmos,phthisis)

☝ Incorrect globe position( hypo or hypertopia )

☝ Brow ptosis

☝ Contralateral lid retraction

☝ Contralateral large globe

 Ptosis Management

✍ Depends upon degree of ptosis and residual Levator function and the cause of ptosis

☝ Mulletectomy

☝Levator resection

☝Levator advancement

☝frontalis sling

 Ptosis Normal lid measurements gift 

✍ Palpebral aperture

☝ 8–11 mm (♀ > ♂)

✍ Upper margin reflex distance

☝ 4–5 mm

✍ Upper lid excursion (levator function)

☝ 13–16 mm

✍ Upper lid crease position

☝ 8-10 mm from margin (♀ > ♂)

 DD of acute dangerous ptosis

✍ Horner

✍ 3rd cranial palsy ( partial or complete)

✍ MG

✍ CPEO

✍ periorbital infection or malignancy

 

examining the lids
examining the lids
Tags: ptosis
Dr.Reda Gomah El Garia

Dr.Reda Gomah El Garia

Consultant Ophthalmologist at MALAZ MEDICAL GROUP

Search Videos

  • About
  • Privacy & Policy
  • Contact

© 2008-2019 Meduweb.

No Result
View All Result
  • Home
  • Free Medical Videos
  • Online Pharmacy
  • Ophthalmology
  • Gynecology and Obstetrics

© 2008-2019 Meduweb.

Welcome Back!

OR

Login to your account below

Forgotten Password?

Retrieve your password

Please enter your username or email address to reset your password.

Log In
This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish.Accept Read More
Privacy & Cookies Policy

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.
Non-necessary
Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.
SAVE & ACCEPT

Add New Playlist