A Study on Etiology, Management of Ptosis in Middle Age Population and its Surgical Outcome

BACKGROUND: Blepharoptosis indicates drooping of upper lid. The causes can be either congenital or acquired. Acquired ptosis can be neurogenic, myogenic, traumatic, senile or mechanical. Management of ptosis depends upon the cause. Treatment of ptosis depends upon age, etiology, severity of ptosis and the levator function. Ptosis surgery restores functional stability to the eyelid. AIM OF THE STUDY: 1.To study the etiology of ptosis between 20 – 50 years of age. 2.Management of various types of ptosis. MATERIALS AND METHODS: Evaluation done with good history taking, and complete general examination and ocular examination. Ocular examination includes visual acuity testing, anterior segment evaluation, ptosis evaluation and posterior segment evaluation. Ptosis evaluation includes examination of Head Posture, Vertical Palpebral Height, Margin Reflex Distance, Lid Crease Level, Levator Palpebrae Superioris Action, Bell’s Phenomenon, Marcus Gunn Jaw Winking Phenomenon, Ice Pack Test, Fatiguability Test, Strabismus Evaluation and Extra Ocular Muscles Motility. Based on clinical examination a clinical diagnosis is arrived and further investigations are done to aid in etiological diagnosis. Patients will also be referred to other departments like neurology department whenever indicated. Patients will be treated accordingly and if managed surgically then the outcome of the surgery is also assessed. RESULTS: Out of 30 cases, the most common ptosis was congenital ptosis (37%) followed by aponeurotic ptosis (26%). The most common acquired ptosis was aponeurotic followed by myogenic (13%), neurogenic (10%), traumatic (7%) and mechanical(7%) ptosis. The most common surgery for congenital ptosis was frontalis sling surgery and for aponeurotic ptosis was levator advancement surgery. All surgeries had good functional outcome. Undercorrection was the most common complication. CONCLUSION: The congenital ptosis incidence was more in 20s while aponeurotic was above 35 years of age indicating etiopathological significance. Surgery forms the main treatment of choice for management of ptosis