Ptosis

Question 1

Bilateral Ptosis ddx

Answer 1

A. Neurological (3rd Nerve Palsy; MG)
B. Muscular (Congenital Myopathy; Congenital absence of levator musle; Dermatomyositis)
C. Syndromes (Myotonia Dystrophica; Fetal Alcohol Syn; Noonan’s Syn; Rubinstein Taybi Syn)

Question 2

Uilateral Ptosis ddx

Answer 2

A. Neurological
1. MG
2. Unilateral 3rd nerve palsy
3. Horner's syndrome
4. Marcus-Gunn Syndrome (jaw open --> improves ptosis due to mixing up of the fibres of 3rd and 5th cranial nerve
B. Congenital ptosis
C. Trauma

Question 3

Steps in examination of ptosis

Answer 3

1. Note whether its Unilateral or Bilateral, Partial or complete.
2. Check for squint, pupil size, light reflexes and accomodation. Ask pt to look up for 60 sec.
3. Note any Myotonic face
4. Note any dysmorphism
5. Test proximal muscles
6. Ask patient to open mouth
   Ask Wallace?? page 47

Question 4

Fetal Alcohol syndrome

Answer 4

1. Maternal alcohol intake >8 to 10 drinks per day (60ml)
2. IUGR
3. Microcephaly, Mild MD
4. Face: Short palpebral fissure, maxilla hypoplasia, short nose, smooth philtrum, thin upper lip, face hirsutism
5. Hypoplastic 5th finger nail
6. Skeletal anomaly
7. Cardiac defect: eg. VSD

Question 5

Fetal Valproate effect

Answer 5

1. Mental retardation
2. Growth deficiency
3. Meningocele
4. Face: Narrow bifrontal diameter; Epicanthic fold; flat nasal bridge; Anteverted nostrils; Long philtrum, Small mouth,; Cleft lip
5. CVS: Congenital heart disease eg. COA, VSD, ASD, AS, Aortic arch defect (Left sided heart defects)
6. Limb: Long thin finger, hyperconvex finger nails