Clinical Pathways in Neuro-ophthalmology : An ... - E-Lib FK UWKS

Is the Ptosis Steroid Induced?
Topical steroids have been implicated in some cases of ptosis. Discontinuation of the
steroids may reverse the ptosis in these cases.
Is Aponeurotic Ptosis Present?
Levator aponeurosis thinning and=or dehiscence may occur as a result of trauma,
surgery, lid swelling, patching, or, most commonly, as an age-related phenomenon
(Frueh, 1996; Liu, 1993; Older, 1995). The characteristic features of aponeurotic ptosis are
listed in Table 18–8.
Patients with aponeurotic ptosis may have significant ptosis in downgaze more than
primary position (Dryden, 1992; Wojno, 1993). In the absence of findings to suggest
mechanical, neurogenic, myogenic, or neuromuscular etiologies for ptosis, no further
evaluation is necessary. Superior visual field loss may occur due to ptosis and may be an
indication for surgical correction. The surgical treatment of aponeurotic ptosis is well
described in the literature and is not reviewed here (Frueh, 1996; Liu, 1993; Older, 1995).
Aponeurotic ptosis does not require any neuroimaging (class III–IV, level B).
An approach to the evaluation of ptosis is outlined in Figure 18–1.
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Ptosis 417
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