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Janet M. LIM, Joshua H. Hou, Ramesh Singa, Vinay Aakalu, Pete Setabutr; Incidence And Demographic Characteristics Of Patients With Different Types Of Ptosis Referred To Oculoplastics At A Tertiary Referral Center. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1449.
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Blepharoptosis is a common complaint in patients referred to any oculoplastics practice. Diagnosis can often be made based on the external appearance and margin to reflex distance 1 (MRD1) alone. However, in many of these ptotic patients the possibility of an underlying systemic or neurological cause for their ptosis often warrants a more detailed evaluation. Based on etiology, ptosis of the eyelid can be categorized as aponeurotic, neurogenic, myogenic, traumatic, or congenital. The purpose of this study is to determine both the incidence and demographic characteristics associated with different types of ptosis in patients referred to oculoplastics at a tertiary referral center.
A retrospective chart review was performed on all patients referred to the oculoplastics department at the University of Illinois Eye and Ear Infirmary between 2007 and 2010. Patients not directly evaluated by an oculoplastics attending or fellow were excluded. Final etiology for each patient’s ptosis was determined based on history and exam; measurements of MRD1, levator function (LF), palpebral fissure in down gaze (↓PF); and ancillary testing such as imaging or serum antibody testing. Demographics, including mean age, sex, and race, were analyzed for patients in each category of ptosis.
In total 252 patients were included in the study. Aponeurotic ptosis was the most common type of ptosis (60.2 %), followed by traumatic (10.8%), congenital (10.4%), mechanical (8.8%), neurogenic (5.6%), and myogenic (3.6%). Of the neurogenic group, 28.6% of patients had a CN 3 palsy, 28.6%% had myasthenia gravis, and 7.1% had Horner’s syndrome. Patients with chronic progressive external ophthalmoplegia (CPEO) comprised 30% of the myogenic group. The average age of presentation for patients with each type of ptosis was: congenital (16.4 years), traumatic (36.4 years), neurogenic (47.8 years), myogenic (53.6 years), mechanical (58.9 years), and aponeurotic (59.5 years). Ptosis secondary to trauma had a statistically higher percentage of males than the overall ptosis group (64.3% vs. 44.4%, p=0.0248 by t-test).
Blepharoptosis is a common reason for patient referral to oculoplastics practices at tertiary referral centers. Aponeurotic ptosis represents the most common etiology for ptosis in these practices, particularly in the aging population. However, in a significant proportion of these patients, more serious conditions such as neurogenic or myogenic ptosis are present. Clinicians should maintain a high degree of suspicion and thoroughly evaluate all patients with ptosis in order to properly assess and treat for underlying systemic associations.
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