Conduite à tenir devant un ptosis

Ptosis is defined as a drooping of the upper eyelid. It often results in functional and/or aesthetic impairment. Although often benign, 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". The history should attempt to detect a daily variation in the ptosis, suggesting myasthenia gravis. Pupillary examination should rule out myosis, which would suggest Claude Bernard-Horner's syndrome (secondary to an internal carotid dissection until proven otherwise), or mydriasis, suggesting an intracranial aneurism. Once an emergency has been ruled out, the clinical examination should assess the levator muscle strength (helpful for determining the underlying etiology) and the Bell's phenomenon (the lack of which is predictive of postoperative corneal exposure). The amount of ptosis is not related to its etiology. At the conclusion of the examination, the physician must be able to classify the ptosis as either pseudoptosis, aponeurotic ptosis, neurogenic ptosis, myogenic ptosis, or junctional ptosis (myasthenia). Except for "urgent ptosis", requiring multidisciplinary medical treatment, surgery is the mainstay of treatment. The surgical technique is based on the etiology of the ptosis, the strength of the levator muscle and the phenylephrine test.