PTOSIS EXAMINATION

DR SRAVYA M V
SECOND YEAR PG
DEPT. OF SALAKYATANTRA
GAVC,TPRA
A. Ocular examination

Look for
• Microphthalmos

• Anophthalmos

• Phthisis bulbi

• Enophthalmos

• To exclude pseudoptosis
Palpebral fissure height in straight/primary gaze – decreased in ptotic side

Palpebral fissure height in downgaze

B . Measurement of degree of ptosis – measuring the amount of cornea
covered by the upper eyelid & subtracting it by 2

• Mild 2 mm

• Moderate 3mm

• Severe 4 mm
C . Margin reflex distance 1

• Distance between the corneal light reflex & the center of the upper eyelid
margin in primary gaze

• Amount of ptosis in
• Unilateral cases – difference between the 2 eyes

• Bilateral cases – difference between MRD 1 & the normal value – 4.5 mm
• Ptotic eyelid covering corneal light reflex – MRD 1 is recorded in negative
numbers – no of millimeters eyelid must be raised to visualize the corneal light
reflex
• MRD 1 - Decreased in ptosis
D . Margin reflex distance 2

• Distance between the corneal light reflex & the center of lower eyelid margin in
primary gaze

• Not required in evaluation of ptosis

• Importance – MRD 1 + MRD 2 = palpebral aperture width

• Normal MRD 2 = 5.5 mm

E. MRD 3

• Distance between corneal light reflex & the center of upper eyelid margin in
extreme up gaze with frontalis muscle action being prevented by direct
pressure applied to the eyebrow

• Measures normal levator function

• 7 mm
F . Margin limbus distance

• Between the margin & the 6 o’ clock limbus in extreme up gaze with frontalis
muscle action being prevented by direct pressure applied to the eyebrow

• Measures normal levator function

• 9 mm
G. Margin crease distance

• Between the center of the eyelid margin to center of the upper eyelid skin
crease in downgaze
H . Levator muscle function

• Berke’s method

• Patient is asked to look in downgaze

• Action of frontalis is prevented by applying direct pressure to the eyebrow

• Zero mark of the scale - at the center of the upper eyelid margin

• Look in the extreme up gaze

• The amount of lid excursion is measured by reading the number on the scale
adjacent to the center of the upper eyelid margin
• Normal 15 mm

• Good 8-15 mm

• Fair 5-7 mm

• Poor < 4 mm
I . Look for

 Bell’s phenomenon

• Tested by trying to open the eyelids after the patient is asked to close the
eyelids tightly

• Normally eyeball will be rolled upwards

 Jaw winking phenomenon

• Tested by asking the patient to open & close the mouth & to move the jaw
from side to side , while observing for the movement of the ptotic eyelid
 Strabismus

• Hypotropia – causes for pseudoptosis

THANK