“Urgent” ptosis: clinical case
Author: Iryna Galinska
Base Hospital / Institution: Medical Centre “Asklepiy” (Zhytomyr, Ukraine)
ePoster presentation
Abstract ID: 24-451
Purpose
Ptosis is defined as a drooping of the upper eyelid. Every ophthalmologist would be able to list,
describe and diagnose conditions that may present with ptosis and can be “urgent”, among of them ptosis may be the first symptom of a life-threatening condition (carotid dissection, intracranial aneurism, generalized myasthenia). Only a rigorous, systematic and clinical examination will allow the physician to distinguish “benign ptosis” from “urgent ptosis”.
Methods
Case presentation
Patient, 58 y.e. with drooping eyelid that appeared 6 months ago, has such symptom as periodic double vision after long visual work.
Vis OD 0.3/1.2 sph +2.25
OS 0.3/1.2 sph. +2.0
Icare 19.0/17.0
Previous Diagnosis: Ptosis OD. Hypermetropia OU. Presbyopia. Initial cataract OU.
Turned to an oculoplastic surgeon with the aim of surgery for ptosis of the right eye.
Results
Patients with ptosis need a detailed examination to identify the cause of ptosis before starting treatment for it. So we use such methods for diagnosing “urgent” ptosis:
Examination: Ice test (+)
Cogan Lid Twitch (+)
Fatigable ptosis (Sympson’s test ) (+)
Double vision test (+)
Hering’s law (+/-)
Sleep/rest test (+)
Proserine’s test (intramuscular injection 1.0 Proserine) (+)
Blood test for Anti Acetylcholine receptor antibodies 12,37 nmol/l (positive)
CT of the chest cavity (pathological changes were not detected).
Diagnosis: Myasthenia gravis. Hypermetropia OU. Presbyopia. Initial cataract OU.
Recommendations: consultation of the neurologist.
Treatment: pirydostygmina bromide 60 mg per os twice a day, methy|prednisolone 16 mg once a day per os
Result: After 3 months of drug treatment the ptosis is absent
Conclusion
Even subtle seemingly isolated ptosis may be the first sigh of a life-threatening condition. Despite the relative simplicity of the diagnosis – ptosis of the eyelids, a multidisciplinary approach to diagnosing the causes of ptosis with the involvement of modern diagnostic equipment is important.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Maryna | Tymoshenko | Medical Centre “Asklepiy” (Zhytomyr, Ukraine) |
| Iryna | Shovtiuk | Medical Centre “Asklepiy” (Zhytomyr, Ukraine) |
