Cataract and Its Clinical Aspects (from Jatoi’s

Clinical Ophthalmology)

Definition of Cataract
• Cataract is the clouding or opacity of the eye's natural lens, leading to a decrease in vision.
• It is a common cause of visual impairment, especially in older adults.

Common Causes of Gradual Visual Loss in Adults

• Cataract
• Age-related Macular Degeneration (AMD)
• Glaucoma
• Diabetic Retinopathy
• Refractive Errors

Causes of Cataracts in Adults

• Aging (Senile Cataract)
• Trauma
• Systemic diseases (e.g., diabetes mellitus)
• Prolonged use of corticosteroids
• Exposure to ultraviolet radiation
• Smoking and alcohol consumption

Causes of Cataracts in Children

• Congenital infections (e.g., rubella, toxoplasmosis)
• Genetic disorders
• Metabolic diseases (e.g., galactosemia)
• Trauma
• Radiation exposure
• Idiopathic (unknown cause)
Presenting Complaints of Cataract Patients
• Painless, progressive decrease in vision
• Glare and difficulty with night driving
• Fading or yellowing of colors
• Frequent changes in glasses
• Double vision in one eye

Clinical Signs in Patients with Cataracts

• Reduced visual acuity
• Lens opacity visible on slit-lamp examination
• Absent red reflex in mature cataracts
• White pupil in advanced cases (leukocoria)
• Poor fundus view due to lens opacity

Steps of Management in Case of Cataract

1. Comprehensive eye examination
2. Assessment of visual acuity and daily function
3. Biometry for intraocular lens (IOL) power calculation
4. Planning and discussing surgery options
5. Cataract extraction with IOL implantation
6. Postoperative care and follow-up

Macular Function Tests in Clear Media

• Amsler Grid Test
• Photostress Recovery Test
• Color Vision Testing
• Contrast Sensitivity Testing

Macular Function Tests in Hazy Media

• Potential Acuity Meter (PAM)
• Laser Interferometry
 • Electrophysiological Tests (e.g., ERG, VEP)

Investigations in Adult Cataract Cases

• Visual acuity assessment
• Slit-lamp examination
• Intraocular pressure (IOP) measurement
• Fundus examination (if possible)
• Biometry for IOL calculation
• B-scan ultrasonography (if fundus view is obscured)

Type of Anesthesia Required Before Cataract Surgery

• Topical anesthesia (commonly used in adults)
• Peribulbar or retrobulbar block
• General anesthesia (used in uncooperative or pediatric patients)

Investigations in Pediatric Cataract Cases

• Ocular examination under anesthesia
• Systemic evaluation for associated conditions
• TORCH screening for congenital infections
• Genetic testing (if hereditary cause suspected)
• Biometry and keratometry for IOL power calculation

Treatment Options for Cataracts

• Non-surgical: Vision aids like glasses (for early stages)
• Surgical:
• Phacoemulsification with IOL implantation (most common)
• Extracapsular Cataract Extraction (ECCE)
• Intracapsular Cataract Extraction (ICCE, rarely used)

Prediction of Postoperative Vision After Cataract Surgery

• Based on preoperative visual acuity
 • Status of the macula and optic nerve
• Absence of other ocular diseases
• Accurate biometry and proper IOL selection

Common Perioperative Cataract Surgery Complications

• Posterior capsular rupture
• Vitreous loss
• Zonular dialysis
• Suprachoroidal hemorrhage
• Intraoperative floppy iris syndrome

Early Postoperative Complications and Treatment

• Endophthalmitis: Requires immediate intravitreal antibiotics
• Corneal Edema: Treated with hypertonic saline
• Increased IOP: Managed with anti-glaucoma medications
• Iritis: Treated with corticosteroid eye drops
• Wound leak: May need surgical repair

Risk Factors for Developing Endophthalmitis and Prevention

Risk Factors:
• Poor aseptic technique
• Contaminated instruments
• Preexisting ocular surface infection
• Immunosuppression
Prevention:
• Preoperative antisepsis (e.g., povidone-iodine)
• Sterilization of surgical instruments
• Use of intracameral antibiotics
• Postoperative antibiotic drops
Late Complications of Cataract Surgery and Treatment
• Posterior Capsule Opacification (PCO): Treated with Nd:YAG laser capsulotomy
• Cystoid Macular Edema: Treated with anti-inflammatory medications
• Retinal Detachment: May require surgical repair
• IOL Dislocation: May need repositioning or replacement

Complications if Cataract is Not Operated Timely

• Progressive visual loss to blindness
• Phacomorphic glaucoma
• Phacolytic glaucoma
• Lens-induced uveitis
• Hyper-mature cataract with risk of rupture or complications

Conjunctiva – Clinical Ophthalmology by S.M.

Jatoi

Differentiating Between Acute Congestive Glaucoma & Uveitis

Acute Congestive Glaucoma:
• Pain: Severe
• Vision: Rapid decrease
• Pupil: Mid-dilated, non-reactive
• Intraocular Pressure (IOP): Elevated
• Cornea: Hazy
• Conjunctiva: Ciliary congestion
Uveitis:
• Pain: Moderate
• Vision: Gradual decrease
 • Pupil: Constricted, sluggish reaction
• IOP: Normal or low
• Cornea: Clear or with keratic precipitates
• Conjunctiva: Circumcorneal redness

Differentiating Between Keratitis & Conjunctivitis

Keratitis:
• Pain: Severe
• Photophobia: Prominent
• Discharge: Minimal
• Cornea: Involved; may have ulcers or opacities
• Vision: Decreased
Conjunctivitis:
• Pain: Mild or absent
• Photophobia: Absent or mild
• Discharge: Mucopurulent or watery
• Cornea: Clear
• Vision: Usually unaffected

Commonest Cause of Viral Conjunctivitis

• Adenovirus is the most common cause.

EKC/Pharyngoconjunctival Fever Symptoms/Signs

Epidemic Keratoconjunctivitis (EKC):
• Onset: Acute
• Symptoms: Redness, watering, foreign body sensation, photophobia
• Signs: Follicular conjunctivitis, preauricular lymphadenopathy, punctate keratitis
Pharyngoconjunctival Fever:
• Symptoms: Sore throat, fever, conjunctivitis
• Signs: Follicular conjunctivitis, preauricular lymphadenopathy
Classification of Conjunctivitis on Discharge Basis
• Serous: Viral
• Mucopurulent: Bacterial
• Purulent: Gonococcal
• Membranous: Diphtheritic
• Pseudomembranous: Adenoviral

Symptoms/Signs of Gonococcal Conjunctivitis

• Symptoms: Profuse purulent discharge, pain, redness, swelling
• Signs: Chemosis, lid edema, corneal ulceration, preauricular lymphadenopathy

Investigations/Treatment of Gonococcal Conjunctivitis

Investigations:
• Gram stain: Gram-negative diplococci
• Culture and sensitivity
Treatment:
• Systemic antibiotics: Ceftriaxone
• Topical antibiotics: Frequent instillation
• Supportive care: Lubricants, cold compresses

Complications of Gonococcal Conjunctivitis

• Corneal ulceration
• Perforation
• Endophthalmitis
• Blindness

Difference Between Papillae and Follicles

Papillae:
• Appearance: Red, velvety elevations
• Location: Upper tarsal conjunctiva
• Associated with: Allergic conjunctivitis
Follicles:
• Appearance: Gray-white, round elevations
• Location: Lower fornix
• Associated with: Viral conjunctivitis

Diagnosis of Trachoma
• Clinical examination: Presence of follicles, papillae, scarring
• Laboratory tests: Giemsa staining, PCR for Chlamydia trachomatis

Complications of Trachoma
• Entropion
• Trichiasis
• Corneal opacity
• Blindness

Arlt Line
• Definition: Linear conjunctival scar on the upper tarsal conjunctiva, indicative of chronic
trachoma.

Treatment of Trachoma, Prevention of Trachoma

Treatment:
• Antibiotics: Azithromycin or tetracycline
Prevention:
• Facial cleanliness
• Environmental improvement
• SAFE strategy: Surgery, Antibiotics, Facial cleanliness, Environmental improvement

W.H.O Classification of Trachoma Grading

• TF: Trachomatous inflammation—follicular
• TI: Trachomatous inflammation—intense
fist co
• TS: Trachomatous scarring
 • TT: Trachomatous trichiasis
• CO: Corneal opacity

Ophthalmia Neonatorum Causes

• Neisseria gonorrhoeae
• Chlamydia trachomatis
• Herpes simplex virus
• Staphylococcus aureus

Treatment of Ophthalmia Neonatorum

• Gonococcal: Systemic and topical antibiotics
• Chlamydial: Oral erythromycin
• Herpetic: Antiviral therapy

VKC Signs/Treatment vernal keratoconjuctivitis

Signs:
• Giant papillae
• Trantas dots
• Limbal hypertrophy
Treatment:
• Topical antihistamines
• Mast cell stabilizers
• Steroids (short-term)
• Cold compresses

Ocular Complications of Cicatricial Pemphigoid/Stevens-Johnson

Syndrome
• Symblepharon
• Conjunctival scarring
• Dry eye
• Corneal ulceration
 • Blindness

Pterygium & Pinguecula

Pterygium:
• Definition: Wing-shaped fibrovascular growth extending onto the cornea
Pinguecula:
• Definition: Yellowish conjunctival nodule near the limbus, not involving the cornea

Complications of Pterygium/Treatment
Complications:
• Astigmatism
• Visual axis involvement
Treatment:
• Surgical excision
• Conjunctival autografting

Difference Between True Pterygium and Pseudo Pterygium

True Pterygium:
• Cause: UV exposure
• Attachment: Firmly adherent to underlying tissue
Pseudo Pterygium:
• Cause: Inflammation or trauma
• Attachment: Loosely adherent

Xerophthalmia Signs/Complications
Signs:
• Conjunctival xerosis
• Bitot's spots
• Corneal xerosis
Complications:
• Corneal ulceration
 • Keratomalacia
• Blindness

Conjunctival Chemosis
• Definition: Edema of the conjunctiva
• Causes: Allergies, infections, trauma
• Management: Treat underlying cause, cold compresses, antihistamines

Cornea – Clinical Ophthalmology by S.M. Jatoi

Layers of Cornea
• Epithelium
• Bowman's layer
• Stroma
• Descemet's membrane
• Endothelium

Functions of Cornea - Refractive Power

• Primary refractive surface of the eye
• Contributes approximately two-thirds of the eye's total refractive power
• Maintains transparency for clear vision

Factors Contributing to Transparency of Cornea

• Avascularity
• Regular arrangement of collagen fibers
• Relative dehydration maintained by endothelial pump
• Smooth epithelial surface
Corneal Diameter and Normal Lid Position in Relevance to
Cornea
• Horizontal diameter: Approximately 11.5–12 mm
• Vertical diameter: Approximately 10.5–11 mm
• Normal lid position: Covers the upper 1–2 mm of the cornea

General Symptoms and Signs of Corneal Disease

• Pain
• Redness
• Photophobia
• Tearing
• Blurred vision
• Foreign body sensation

Diagnosis of Keratitis
• Clinical examination: Slit-lamp biomicroscopy
• Corneal staining: Fluorescein dye to detect epithelial defects
• Microbiological tests: Corneal scraping for culture and sensitivity

Treatment of Keratitis
• Bacterial keratitis: Topical antibiotics
• Viral keratitis: Antiviral agents (e.g., acyclovir)
• Fungal keratitis: Antifungal agents (e.g., natamycin)
• Supportive therapy: Lubricants, cycloplegics

Treatment of Corneal Ulcer

• Empirical broad-spectrum antibiotics initially
• Tailored therapy based on culture results
• Cycloplegic agents to relieve pain
• Close monitoring for complications
Fluorescein and Rose Bengal Stain - Uses
• Fluorescein: Highlights epithelial defects
• Rose Bengal: Stains devitalized cells and mucus

Principles of Management of Corneal Ulcer - General

• Prompt initiation of antimicrobial therapy
• Avoidance of corticosteroids in active infection
• Regular follow-up to monitor healing
• Management of underlying causes

Risk Factors for Bacterial Corneal Ulcer

• Contact lens wear
• Trauma
• Ocular surface disease
• Immunosuppression

Risk Factors for Fungal Keratitis

• Vegetative trauma
• Chronic ocular surface disease
• Prolonged use of topical steroids
• Hot and humid climates

Complications of Corneal Ulcer

• Corneal perforation
• Scarring
• Endophthalmitis
• Vision loss

Hypopyon Ulcer
• Definition: Corneal ulcer associated with pus in the anterior chamber
• Commonly caused by: Pseudomonas aeruginosa
Acanthamoeba Keratitis
• Etiology: Acanthamoeba species
• Risk factors: Contact lens use, exposure to contaminated water
• Symptoms: Severe pain, redness, photophobia
• Diagnosis: Confocal microscopy, culture
• Treatment: Topical anti-amoebic agents

Herpes Simplex Keratitis (HSK) - Stages

• Epithelial keratitis: Dendritic ulcers
• Stromal keratitis: Immune-mediated inflammation
• Endothelial keratitis (Disciform): Involvement of endothelium

Complications of HSK and Treatment

• Complications: Scarring, neovascularization, decreased vision
• Treatment: Antiviral therapy, cautious use of steroids under supervision

Disciform Keratitis - Signs and Treatment

• Signs: Central corneal edema, keratic precipitates
• Treatment: Topical steroids with antiviral coverage

Herpes Zoster Ophthalmicus (HZO) - Symptoms, Signs,

Treatment
• Symptoms: Pain, rash in the distribution of the ophthalmic branch of trigeminal nerve
• Signs: Vesicular rash, conjunctivitis, keratitis
• Treatment: Oral antivirals (e.g., acyclovir), pain management

Complications of HZO
• Chronic ocular inflammation
• Neurotrophic keratitis
• Secondary glaucoma
 • Vision loss

Keratoconus - Symptoms, Signs, Ocular, and Systemic

Associations
• Symptoms: Progressive myopia, astigmatism, blurred vision
• Signs: Conical protrusion of cornea, Fleischer's ring, Vogt's striae
• Associations: Down syndrome, atopic diseases

Keratoconus Diagnosis and Treatment

• Diagnosis: Corneal topography
• Treatment: Spectacles, contact lenses, corneal cross-linking, keratoplasty in advanced cases

Exposure Keratopathy - Causes and Treatment

• Causes: Lagophthalmos, facial nerve palsy tes, ectropion
• Treatment: Lubricants, moisture chambers, surgical correction

Filamentary Keratitis - Treatment

• Treatment: Removal of filaments, lubricants, hypertonic saline, treatment of underlying dry
eye

Arcus Senilis and Band Keratopathy

• Arcus Senilis: Peripheral corneal lipid deposition, common in elderly
• Band Keratopathy: Calcium deposition in the superficial cornea, associated with chronic
inflammation

Keratoplasty Types and Indications

• Types:
• Penetrating keratoplasty (PK): Full-thickness corneal transplant
• Lamellar keratoplasty: Partial-thickness transplant
• Indications: Corneal scarring, keratoconus, endothelial dysfunction
Contact Lenses - Indications and Complications
• Indications: Refractive errors, keratoconus, therapeutic uses
• Complications: Infections, hypoxia, corneal abrasions

Refractive Corneal Surgery - Indications and Types

• Indications: Myopia, hyperopia, astigmatism
• Types: LASIK, PRK, SMILE

Glaucoma – Clinical Ophthalmology by S.M.

Jatoi

Define Glaucoma
Glaucoma is a group of eye disorders characterized by progressive optic neuropathy, often
associated with elevated intraocular pressure (IOP), leading to characteristic visual field defects and
potential vision loss.

Highest Resistance to Aqueous Outflow

The highest resistance to aqueous humor outflow occurs at the juxtacanalicular trabecular
meshwork, adjacent to Schlemm's canal.

Ocular Hypertension
Ocular hypertension refers to consistently elevated IOP without detectable glaucomatous damage to
the optic nerve or visual fields.

Types of Glaucoma – Primary Open Angle Glaucoma (POAG)

POAG is the most common form of glaucoma, characterized by an open anterior chamber angle,
progressive optic nerve damage, and visual field loss, often with elevated IOP.

Aetiology/Pathogenesis of POAG
POAG results from increased resistance to aqueous outflow through the trabecular meshwork,
leading to elevated IOP and subsequent optic nerve damage.
Risk Factors in POAG
• Elevated IOP
• Age over 40 years
• Family history of glaucoma
• African descent
• Myopia
• Diabetes mellitus
• HypertensionWikipedia

Methods of IOP Evaluation

n gpt
• Goldmann applanation tonometry
• Non-contact (air-puff) tonometry
• Tono-Pen
• Perkins tonometerWikipedia+2Wikipedia+2Wikipedia+2WikipediaWikipedia

Routine Checkup Revealed High IOP – How to Proceed

• Repeat IOP measurements at different times
• Comprehensive ocular examination
• Optic nerve head evaluation
• Visual field testing
• Optical coherence tomography (OCT)Wikipedia+1Wikipedia+1Wikipedia

Diagnostic Criteria of POAG

• Open anterior chamber angle
• Elevated IOP
• Characteristic optic disc changes (e.g., increased cup-to-disc ratio)
• Corresponding visual field defects

Different Methods of Visual Field Analysis

• Humphrey Visual Field Analyzer
 • Goldmann perimetry
• Frequency Doubling Technology (FDT)
• Short-Wavelength Automated Perimetry
(SWAP)Wikipedia+2Wikipedia+2Wikipedia+2WikipediaWikipedia+2Wikipedia+2Wikipedi
a+2

Glaucomatous Visual Field Defects

• Paracentral scotomas
• Nasal steps
• Arcuate (Bjerrum) scotomas
• Generalized depression
• Tunnel vision in advanced stagesWikipedia+1Wikipedia+1Wikipedia+1Wikipedia+1

Why Called "Kala Motia"/Silent Thief of Vision (POAG)

POAG is termed "Kala Motia" in local languages and "silent thief of vision" because it progresses
slowly without noticeable symptoms until significant vision loss occurs.

OCT (Optical Coherence Tomography) – Importance in Eye

Disease
OCT provides high-resolution cross-sectional images of the retina and optic nerve head, aiding in
early detection and monitoring of glaucomatous changes.

Treatment of Open Angle Glaucoma

• Medical Therapy:
• Prostaglandin analogs
• Beta-blockers
• Alpha agonists
• Carbonic anhydrase inhibitors
• Laser Therapy:
• Laser trabeculoplasty
• Surgical Therapy:
• Trabeculectomy
 • Glaucoma drainage devicesWikipedia

Narrow Angle Glaucoma (PACG) – Pathogenesis, Different Stages

PACG occurs due to closure of the anterior chamber angle, leading to impaired aqueous outflow.
Stages include:
• Prodromal stage
pia
• Intermittent attacks
• Acute angle-closure
• Chronic angle-closureWikipedia+1Wikipedia+1Wikipedia+4Wikipedia+4Wikipedia+4

Intermittent Narrow Angle Glaucoma

Characterized by transient episodes of angle closure with symptoms like blurred vision and halos,
resolving spontaneously.

Symptoms of Acute Congestive Glaucoma

• Severe ocular pain
• Headache
• Nausea and vomiting
• Blurred vision
• Halos around lights

Signs of Acute Congestive Glaucoma

• Elevated IOP
• Mid-dilated, non-reactive pupil
• Corneal edema
• Conjunctival injection
• Shallow anterior chamber

Treatment of Acute Congestive Glaucoma

• Immediate IOP reduction with medications (e.g., acetazolamide, topical beta-blockers)
• Laser peripheral iridotomy
• Surgical intervention if necessary
Provocative Test in Narrow Angle Glaucoma
Dark room test and prone test are used to provoke angle closure in susceptible individuals.

Difference Between Open Angle & Closed Angle Glaucoma

Feature Open Angle Glaucoma Closed Angle Glaucoma
Angle Status Open Closed or narrow
Onset Gradual Sudden
Symptoms Often asymptomatic Severe symptoms
IOP Elevated Markedly elevated
Treatment Medications, laser, surgery Emergency treatment required

Buphthalmos
Buphthalmos refers to an enlarged eyeball due to congenital glaucoma, typically presenting in
infants.

Secondary Glaucomas
Secondary glaucomas result from identifiable causes, such as:
• Uveitis
• Trauma
• Steroid use
• Lens-induced mechanismsWikipedia+2Wikipedia+2Wikipedia+2

Lens-induced Glaucomas
Glaucomas caused by lens abnormalities, including:Wikipedia
• Phacomorphic glaucoma
• Phacolytic glaucoma
• Lens particle glaucomaWikipedia+4Wikipedia+4Wikipedia+4

Difference Between Phacomorphic & Phacolytic Glaucoma

Feature Phacomorphic Glaucoma Phacolytic Glaucoma
Intumescent lens causing angle Leakage of lens proteins from hypermature
Cause
closure cataract
Mechanism Mechanical blockage Inflammatory response
 Feature Phacomorphic Glaucoma Phacolytic Glaucoma
IOP Elevated Elevated
Treatment Lens extraction Lens extraction

Refractive Error Related to Which Type of Glaucoma

• Myopia is associated with POAG.
• Hyperopia is associated with PACG.

Steroid-Induced Glaucoma
Prolonged use of corticosteroids can lead to increased IOP and secondary open-angle glaucoma.

Different Surgical Procedures for Glaucoma

• Trabeculectomy
• Glaucoma drainage devices
• Laser trabeculoplasty
• Cyclodestructive proceduresWikipedia

Visual Field Defects in Glaucoma

• Paracentral scotomas
• Nasal steps
• Arcuate scotomas
• Tunnel vision in advanced stagesWikipedia+1Wikipedia+1Wikipedia+1Wikipedia+1

Visual Field Defects in Optic Neuritis

• Central scotoma
• Altitudinal defects
• Generalized depressionWikipedia+2Wikipedia+2Wikipedia+2
Eyelid – Clinical Ophthalmology by S.M. Jatoi

Layers of the Lid

The eyelid comprises the following layers:[Link]+1Wikipedia+1
1. Skin: Thin and elastic. Ant. and Post. lamella
2. Subcutaneous Tissue: Loose connective tissue. tarsal plate
3. Orbicularis Oculi Muscle: Responsible for eyelid closure.
4. Orbital Septum: Fibrous membrane separating the eyelid from the orbital contents.
5. Tarsal Plate: Dense connective tissue providing structural support.
6. Palpebral Conjunctiva: Inner lining of the [Link]+1NCBI+1

Gray Line
The gray line is a subtle groove between the anterior and posterior lamellae of the eyelid margin,
serving as a surgical landmark. Ento Key

Blepharitis
Blepharitis is a chronic inflammation of the eyelid margins, often involving the glands of Zeis and
Moll. Wikipedia+2KorAcademy+2Wikipedia+2

Types of Blepharitis
1. Ulcerative (Staphylococcal) Blepharitis: Characterized by red eyelid margins, edema,
yellow pus, crusting, and matted eyelashes.
2. Squamous (Seborrheic) Blepharitis: Features white dandruff on margins, shiny waxy
eyelids, greasy eyelashes, and red eyelids with edema. KorAcademy

Variety Common in Kids

Ulcerative blepharitis is more prevalent in children. KorAcademy+1KorAcademy+1
Type Common in Old Age
Squamous blepharitis is more common in the elderly. KorAcademy

Association of Blepharitis
Blepharitis is associated with conditions like trichiasis, madarosis, poliosis, stye, chalazion, ptosis,
recurrent bacterial conjunctivitis, keratitis, and tear film instability. KorAcademy

Common Symptoms of Blepharitis

• Redness and swelling of eyelids
• Crusting and scaling at the eyelid margins
• Itching and burning sensation
• Foreign body sensation
• PhotophobiaWikipedia+1KorAcademy+1

Common Signs of Blepharitis

• Eyelid margin redness and edema
• Crusts and scales at the base of eyelashes
• Matted eyelashes
• Loss of eyelashes (madarosis)
• White dandruff-like flakes (in squamous
type)KorAcademy+2Wikipedia+2AAO+2KorAcademy

Treatment of Blepharitis
• Eyelid hygiene with warm compresses
• Topical antibiotic ointments
• Topical steroids (if inflammation is severe)
• Artificial tears for associated dry eye symptoms Wikipedia+2Wikipedia+2NCBI+2

Difference Between Anterior and Posterior Blepharitis

• Anterior Blepharitis: Affects the front of the eyelid margin; commonly due to
staphylococcal infection or seborrheic dermatitis.
 • Posterior Blepharitis: Involves the inner eyelid margin and meibomian glands; often
associated with meibomian gland [Link]

Complications of Blepharitis
• Trichiasis (misdirected eyelashes)
• Madarosis (loss of eyelashes)
• Poliosis (whitening of eyelashes)
• Stye and chalazion formation
• Ptosis
• Recurrent conjunctivitis
• Keratitis and corneal ulcers Scribd+2KorAcademy+[Link]+2Wikipedia

Ptosis
Ptosis is the drooping of the upper eyelid due to dysfunction of the muscles responsible for eyelid
elevation.

Types of Ptosis
1. Congenital Ptosis: Present at birth; may be due to developmental issues in the levator
muscle.
2. Acquired Ptosis: Develops later in life; causes include neurogenic, myogenic, aponeurotic,
mechanical, or traumatic [Link]

Clinical Evaluation of Ptosis

• Measurement of palpebral fissure height
• Assessment of levator function
• Evaluation of extraocular movements
• Observation for compensatory head postures
• Inspection for eyelid crease position

Difference Between Congenital and Acquired Ptosis

• Congenital Ptosis: Typically unilateral, absent eyelid crease, and reduced levator function.
• Acquired Ptosis: May be bilateral, with a well-formed eyelid crease; causes include nerve
palsies, muscle diseases, or aponeurotic dehiscence. KorAcademy
Treatment Options for Ptosis
• Surgical:
• Levator resection or advancement
• Frontalis sling operation (especially in poor levator function)
• Non-Surgical:
• Ptosis crutches (eyeglass attachments)
• Treatment of underlying cause in acquired cases

Complications of Ptosis if Not Treated

• Amblyopia (lazy eye) in children
• Cosmetic concerns
• Visual field defects
• Neck strain due to compensatory head postureWikipedia

Right Time for Correction of Ptosis

Surgical correction is recommended before school age in children to prevent amblyopia and
psychosocial issues.

Bell's Phenomenon
Bell's phenomenon is the upward and outward movement of the eye when an attempt is made to
close the eyes forcibly; it is a protective mechanism.

Common Lid Tumors

• Benign:
• Chalazion
• Papilloma
• Seborrheic keratosis
• Malignant:
• Basal cell carcinoma (most common)
• Squamous cell carcinoma
 • Sebaceous gland
carcinomaWikipedia+2Wikipedia+[Link]+2KorAcademy+1Wikipedia+
1

Treatment of Basal Cell Carcinoma

• Surgical excision with clear margins
• Mohs micrographic surgery in recurrent or high-risk cases

Treatment of Squamous Cell Carcinoma

• Wide local excision with histopathological margin control
• Radiation therapy in inoperable cases

Difference Between Stye and Chalazion

• Stye (Hordeolum): Acute, painful infection of the eyelid glands, usually external (glands of
Zeis) or internal (meibomian glands).
• Chalazion: Chronic, painless granulomatous inflammation of a meibomian gland.

Chalazion
A chalazion presents as a painless, firm lump in the eyelid due to blockage of a meibomian
[Link]

Stye
A stye is a painful, red swelling on the eyelid margin resulting from an acute bacterial infection of
the eyelid glands.

Entropion
Entropion is the inward turning of the eyelid margin, causing eyelashes to rub against the cornea,
leading to irritation.

Ectropion
Ectropion is the outward turning of the eyelid margin, leading to exposure of the conjunctiva and
potential dryness and irritation.