Archives: Lessons

Off-label Pharmaceutical Therapies Several off-label pharmaceutical therapies have been shown to improve ptosis. These therapies are sympathomimetic agents that potentially activate Müller’s muscle due to its expression of alpha-adrenergic receptors.1 However, only a few of these therapies are clinically useful.  Apraclonidine Apraclonidine 0.5% ophthalmic solution is an alpha-adrenergic receptor agonist prescribed for glaucoma. It is FDA … Continued

Click to download and print the course. To get the most out of this course, we recommend completing it in an environment free from distractions. Platform Instructions If you prefer to print the course and test questions, the PDF version is located below. Download & Print Courses are now broken down into Lessons. You can … Continued

Myogenic Myogenic ptosis is a dysgenesis of the levator palpebrae superioris, commonly due to systemic muscular dysfunctions, including chronic progressive external ophthalmoplegia (CPEO), oculopharyngeal muscle dystrophy (OPMD), and myotonic dystrophy. This rare subtype of ptosis tends to present bilaterally and is progressive. Myogenic ptosis may also be present in MG patients. Mechanical Excess weight or alteration of … Continued

Neurogenic Neurogenic ptosis, a relatively rare subtype, is secondary to a defect to CN3 or the sympathetic nerves that innervate the muscles of the upper eyelid. When neurogenic ptosis is suspected, the diagnostic triad of eyelid position, pupillary examination, and extraocular motility needs to be thoroughly evaluated. Several potential etiologies are possible, with some being life … Continued

Etiology of Acquired Blepharoptosis Acquired ptosis is typically classified by its etiological origin into the following subtypes: aponeurotic, neurogenic, myogenic, mechanical, and traumatic1 (Table 2). Table 2. Summary of Subtypes of Acquired Blepharoptosis Aponeurotic Aponeurotic, or involutional, ptosis is the most common acquired form and is usually related to aging. It occurs due to the levator … Continued

Pseudoptosis Pseudoptosis gives the appearance of ptosis in the absence of any pathology of the upper eyelid muscles or levator aponeurosis. This condition is due to pathologies of other anatomical structures that can inadvertently affect the position of the eyelid. The above-mentioned testing can help rule out cases of pseudoptosis, such as globe asymmetry, globe … Continued

Globe Position and Size Asymmetry in the globe position and size between the two eyes should be noted. Sometimes, a patient that presents with a possible ptosis does not have a lower eyelid but has globe dystopia, such as enophthalmos (posterior displacement of the eye). Exophthalmos or proptosis may suggest a mass within the orbit. Measuring … Continued

Table 1. Diagnostic Testing in the Clinical Examination for Blepharoptosis Clinical Examination A thorough examination is necessary for the patient who presents with ptosis to determine the underlying etiology, and more importantly, to avoid missing a potentially serious neurologic condition. The optometrist should perform a visual evaluation of the ptotic patient, paying particular attention to the … Continued

Functional and Psychological Impact Ptosis can negatively affect patients both functionally and psychologically. A physical blockage of the pupil due to upper eyelid ptosis can cause superior visual field loss, detected in studies using static perimetry testing. This limitation in visual function has been found to impact patients’ lives through decreased health-related quality of life from … Continued

Raise the Bar in Clinical Care: Elevate the Ptotic Eyelid Introduction Blepharoptosis, commonly known as “ptosis,” is defined as an abnormal drooping of the upper eyelid, either unilaterally or bilaterally. The predominant treatment for ptosis has been surgery due to a lack of effective non-surgical options over the years. However, the recent approval of a pharmacological … Continued

References https://web.s.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=a958f380-72e9-4e31-8d77-eb7cdf4975cc%40redis (Scoping Out Optometry’s Next Era) Anatomy of cornea and ocular surface. Mittanamalli S Sridhar Indian J Ophthalmology 2018 Feb; 66(2): 190-194 https://pubmed.ncbi.nlm.nih.gov/35830289/ ncbi.nlm.nih.gov/books/NBK544295/#:~:text=The%20four%20primary%20groups%20of,keratan%20sulfate%2C%20and%20hyaluronic%20acid. https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323672405000020 “Traumatic Cataract and Intralenticular Foreign Body.” Clinical & Experimental Ophthalmology, vol. 33, no. 6, Dec. 2005, pp. 660–61. EBSCOhost, https://doi.org/10.1111/j.1442-9071.2005.01115.x. https://www.sciencedirect.com/topics/medicine-and-dentistry/traumatic-cataract#:~:text=Equatorial%20expansion%20of%20the%20globe%20occurs%20when%20it%20is%20shortened,%2C%20zonular%20dehiscence%2C%20or%20both.&text=Cataracts%20can%20form%20following%20disruption%20of%20the%20lens%20capsule. https://eyewiki.aao.org/Intraocular_Foreign_Bodies_(IOFB) https://www.ncbi.nlm.nih.gov/books/NBK567781/#:~:text=Siderosis%20bulbi%20refers%20to%20the,iron%20derived%20from%20the%20blood.

Foreign Body Treatment/Management You may now feel very confident in your ability to identify characteristic signs/symptoms, remove foreign bodies, and manage postoperative complications with foreign bodies. However, there is one more vital component in handling foreign bodies and that is how they’re treated and managed. Following the initial visit, it is highly recommended that the … Continued

Foreign Body Removal Complications As a general rule of thumb, it can be presumed that foreign bodies that are more superficial and peripheral are less likely to have adverse effects following foreign body removal. When discussing with my patients the risks and benefits of foreign body removal, I like to compare the eye and the … Continued

Indications/Contraindications with Foreign Bodies A foreign body removal is indicated in the presence of any foreign body that presents within the conjunctiva and/or cornea,  has negative Seidel, and no suspicion of intraocular foreign body. As discussed in the prior section, if there is a positive Seidel or identified/suspected intraocular foreign body, foreign body removal should … Continued

Tools Used in Effectively Removing Foreign Bodies Once you are able to develop a consistent routine in how you perform foreign body removal, all of the following options you have to choose from will be second nature in working with. The most essential tool of all for optometrists to use in removing foreign bodies is … Continued

Foreign Body Materials and their Respective Reactions Similar to location of injury, size of foreign body, and the secondary complications that result, the type of foreign body plays a large role in the visual prognosis for a patient. Metals and organic matter are generally the least tolerated by the eye and unfortunately metal is the … Continued

Signs of Foreign Bodies Foreign bodies can result in a host of signs depending on the location they present in. If the foreign body is located more anteriorly in the eyelid, whether it be in the palpebral conjunctiva or conjunctival fornices, one may see eyelid edema, diffuse injection, and superficial punctate keratitis (SPK). Eyelid edema … Continued

Symptoms of Foreign Bodies Listed above in some of the ocular anatomy review sections a few of the signs and symptoms are discussed, however this section aims to describe in further detail why the patients experience what they do and why we see what we do in the event of a foreign body. If we … Continued

Posterior to the cornea is the first chamber of the eye, better known as the anterior chamber. The anterior chamber is an optically empty space in normal physiological conditions. In the event of a foreign body, there often is no presence of foreign body, rather the presence of immune cells within the aqueous humor filling … Continued