From the Research
The workup of ptosis should begin with a thorough history and physical examination to determine the cause, including assessment of onset, duration, progression, and associated symptoms like diplopia, pain, or neurological symptoms. The physical examination should include measurement of the palpebral fissure height, margin reflex distance, levator function, and assessment for fatigability 1. Key points to consider in the physical examination include:
- Palpebral fissure height
- Margin reflex distance
- Levator function test
- Upper eyelid crease
- Assessment for pupillary abnormalities, extraocular movement limitations, and other neurological signs
Basic diagnostic tests may include:
- Ice pack test to assess for myasthenia gravis
- Phenylephrine test to assess potential response to surgical correction
- Laboratory tests such as acetylcholine receptor antibodies, thyroid function tests, and inflammatory markers
- Imaging studies like MRI of the brain and orbits to rule out structural lesions
- Neurophysiological tests such as electromyography to diagnose myasthenic conditions 2, 3
The workup should be tailored based on suspected etiology, which could range from age-related aponeurotic ptosis to neurological conditions like myasthenia gravis, third nerve palsy, or Horner's syndrome 4, 1. Prompt referral to ophthalmology, neurology, or oculoplastic surgery may be necessary depending on the suspected cause and severity. It is essential to consider the patient's overall clinical presentation and medical history when determining the best course of action for diagnosis and treatment.