PTOSIS

Ask the Following Questions:

1. Are there abnormalities on the eye examination? Pseudoptosis occurs when there is inflammation of the eyelid, cornea, or other ocular structures. Periorbital edema, conjunctivitis, and trachoma are among the many disorders to consider.
2. Is it intermittent? Intermittent ptosis would suggest myasthenia gravis, ophthalmoplegic migraine, and transient ischemic attacks.
3. Is it partial? The presence of partial ptosis should suggest Horner's syndrome, especially if there is a constricted pupil. However, myotonic dystrophy, myasthenia gravis, and progressive muscular atrophy are just three of the disorders that may present with partial ptosis.
4. Is there a dilated pupil? The presence of a dilated pupil, especially with a unilateral ptosis, suggests a ruptured cerebral aneurysm. However, if the dilated pupil is associated with many other neurologic signs, then there are many other conditions to consider.
5. Is there a constricted pupil? The presence of a constricted pupil with unilateral complete ptosis would suggest diabetic neuropathy. However, if there is bilateral complete ptosis, chronic progressive external ophthalmoplegia and myasthenia gravis should be considered.
6. Are there other cranial nerves involved? The presence of other cranial nerve signs should suggest cavernous sinus thrombosis, cerebral aneurysm, tuberculous meningitis, syphilitic meningitis, Wernicke's encephalopathy, diphtheria, and subdural hematoma.
7. Are there hyperactive reflexes? The presence of hyperactive reflexes would suggest syringomyelia, platybasia, brain stem tumors, vertebral basilar occlusion or insufficiency, multiple sclerosis, epidemic encephalitis, and general paresis.
8. Are there hypoactive reflexes? The presence of hypoactive reflexes would suggest myotonic dystrophy, tabes dorsalis, and progressive muscular atrophy.

DIAGNOSTIC WORKUP

If there are local conditions responsible for the ptosis, then a smear and culture of the exudate and slit lamp examination or tonometry can be done, or the patient should be referred to an ophthalmologist. If a neurologic disease is suspected, a neurologist should be consulted, especially if the onset is acute.

Routine diagnostic tests include a CBC, sedimentation rate, urinalysis, chemistry panel, glucose tolerance test, ANA, VDRL test, and x-rays of the skull and sinuses. A CT scan or MRI of the brain must be done in most cases. If myasthenia gravis is suspected, a Tensilon test and acetylcholine receptor antibody titer can be done.

If encephalitis, meningitis, central nervous system lues, or multiple sclerosis are suspected, a spinal tap may be useful. Intravenous thiamine is administered in Wernicke's encephalopathy. If Horner's syndrome is suspected, the workup may be found on page 227 . If muscular dystrophy is suspected, a 24-hr urine collection for creatinine and creatine and a muscle biopsy may be done. Cerebral angiography will be necessary to diagnose most cerebral aneurysms and cerebral vascular disease, including transient ischemic attacks.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

Other Book Chapters Related to Eyelid symptoms

Read excerpts from these other book chapters related to Eyelid symptoms:

Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

More About Causes of Eyelid symptoms

• Back to symptom: Eyelid symptoms: Introduction (review 664 causes)
• Next Book Extract About Eyelid symptoms: Ptosis (In a Page: Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Eyelid symptoms

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

 » Next page: Ptosis (In a Page: Signs and Symptoms)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Ptosis (In a Page: Signs and Symptoms)
• Ptosis (In A Page: Pediatric Signs and Symptoms)
• PTOSIS (Differential Diagnosis in Primary Care)
• Ptosis (Handbook of Signs & Symptoms (Third Edition))
• Ptosis (Professional Guide to Diseases (Eighth Edition))

Tools & Services:

• Bookmark this page
• Take a survey relating to Eyelid symptoms
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City