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Full dissertation report on Ptosis crutch
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Dissertation I had done in my final years of study on ways to deal with ptosis. Treatments, pros and cons etc. upper honours achieved
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Department of Vision SciencesBSc (Hons) DISSERTATION REPORT
Title: A non-surgical treatment option to
elevate the upper eyelids due to ptosis
Table of Contents
Abstract..........................................................................6
Section 1: Introduction....................................................7
1.1: Aetiology of ptosis...........................................................................7
1.2: Eyelid muscles..................................................................................7
1.3: Causes of ptosis...............................................................................8
1.4: Surgical treatment...........................................................................8
, 1.5: Ptosis crutch: A safe and effective treatment...................................9
1.6: Overview of dissertation................................................................10
Section 2: The Anatomy of the Eyelid.............................11
2.1: Facial anatomy...............................................................................11
2.1.2: Nerve supply....................................................................................................11
2.1.3: Facial muscles..................................................................................................11
2.2: Upper eyelid and lower eyelid anatomy.........................................12
2.3: Layers of the eyelid........................................................................12
2.4: Skin and subcutaneous tissue........................................................14
2.5: Orbicularis oculi.............................................................................14
2.5.1: Anatomy...........................................................................................................14
2.5.2: Nerve supply....................................................................................................15
2.5.3: Blood supply.....................................................................................................15
2.6: Tarsal plates...................................................................................15
2.6.1: Anatomy...........................................................................................................15
2.6.2: Divisions...........................................................................................................15
2.6.3: Structure..........................................................................................................16
2.7: Orbital septum...............................................................................16
2.7.1: Anatomy...........................................................................................................16
2.8: Levator palpebrae superioris.........................................................17
2.8.2: Nerve supply....................................................................................................17
2.8.3: Blood supply.....................................................................................................17
2.9: Mullers muscle...............................................................................17
2.9.2: Nerve supply....................................................................................................18
2.11: Palpebral conjunctiva...................................................................18
2.12: Eyelid movement.........................................................................18
Section 3: Ptosis and Visual Impairment........................19
3.0: Aetiology........................................................................................19
3.1: Congenital ptosis............................................................................19
3.1.1: Double elevator palsy......................................................................................19
3.1.2: Simple ptosis....................................................................................................20
3.1.3: Third nerve palsy..............................................................................................21
3.2: Acquired Ptosis..............................................................................21
3.2.1 Aponeurotic ptosis............................................................................................22
3.2.2: Myogenic..........................................................................................................22
3.2.3: Neurogenic.......................................................................................................23
, 3.2.4: Mechanical.......................................................................................................24
3.2.5: Traumatic.........................................................................................................24
Section 4: Ptosis Correction...........................................25
4.1: Surgery and its complications........................................................25
4.2: Ptosis crutch- a non-surgical and safe solution...............................27
4.2.1: Nylon loop........................................................................................................27
4.2.2: Lundie loop......................................................................................................28
4.2.3: Half loop...........................................................................................................29
4.3: Changes and advancements...........................................................29
4.3.1: 3D printing.......................................................................................................29
4.3.2: Change in construction....................................................................................31
.............................................................................................................32
4.5: Other Forms of Correction.............................................................33
4.5.1: Eyelid taping and gluing...................................................................................33
4.5.2: Scleral contact lenses.......................................................................................34
Section 5: Dry eye caused by ptosis crutch.....................37
5.1: Tears function................................................................................37
5.2: Exposure of the ocular surface.......................................................39
5.3: Importance of blinking and tear production...................................41
5.4: Treatments....................................................................................43
5.4.1: Lubricating drops.............................................................................................43
5.4.2: MEGs (Micro Environment Glasses)................................................................43
Section 6: Conclusion.....................................................45
Reference list................................................................47
Abstract..........................................................................5
Acknowledgements.........................................................6
Section 1: Introduction....................................................7
1.1: Aetiology of ptosis...........................................................................7
1.2: Eyelid muscles.................................................................................7
1.3: Causes of ptosis...............................................................................8
1.4: Surgical treatment...........................................................................8
1.5: Ptosis crutch: A safe and effective treatment...................................9
, 1.6: Overview of dissertation................................................................10
Section 2: The Anatomy of the Eyelid............................11
2.1: Facial anatomy...............................................................................11
2.1.2: Nerve supply....................................................................................................11
2.1.3: Facial muscles..................................................................................................11
2.2: Upper eyelid and lower eyelid anatomy........................................12
2.3: Layers of the eyelid........................................................................12
2.4: Skin and subcutaneous tissue........................................................13
2.5: Orbicularis oculi.............................................................................14
2.5.1: Anatomy...........................................................................................................14
2.5.2: Nerve supply....................................................................................................14
2.5.3: Blood supply....................................................................................................14
2.6: Tarsal plates...................................................................................15
2.6.1: Anatomy...........................................................................................................15
2.6.2: Divisions...........................................................................................................15
2.6.3: Structure..........................................................................................................16
2.7: Orbital septum...............................................................................16
2.7.1: Anatomy...........................................................................................................16
2.8: Levator palpebrae superioris.........................................................16
2.8.2: Nerve supply....................................................................................................17
2.8.3: Blood supply....................................................................................................17
2.9: Mullers muscle...............................................................................17
2.9.2: Nerve supply....................................................................................................17
2.11: Palpebral conjunctiva...................................................................18
2.12: Eyelid movement.........................................................................18
Section 3: Ptosis and Visual Impairment........................19
3.0: Aetiology.......................................................................................19
3.1: Congenital ptosis...........................................................................19
3.1.1: Double elevator palsy......................................................................................19
3.1.2: Simple ptosis....................................................................................................20
3.1.3: Third nerve palsy.............................................................................................21
3.2: Acquired Ptosis..............................................................................21
3.2.1 Aponeurotic ptosis............................................................................................21
3.2.2: Myogenic.........................................................................................................22
3.2.3: Neurogenic.......................................................................................................23
3.2.4: Mechanical.......................................................................................................24
, 3.2.5: Traumatic.........................................................................................................24
Section 4: Ptosis Correction...........................................25
4.1: Surgery and its complications........................................................25
4.2: Ptosis crutch- a non-surgical and safe solution...............................27
4.2.1: Nylon loop........................................................................................................27
4.2.2: Lundie loop......................................................................................................28
4.2.3: Half loop...........................................................................................................29
4.3: Changes and advancements...........................................................29
4.3.1: 3D printing.......................................................................................................29
4.3.2: Change in construction....................................................................................31
4.5: Other Forms of Correction.............................................................33
4.5.1: Eyelid taping and gluing...................................................................................33
4.5.2: Scleral contact lenses.......................................................................................34
Section 5: Dry eye caused by ptosis crutch.....................37
5.1: Tears function................................................................................37
5.2: Exposure of the ocular surface.......................................................39
5.3: Importance of blinking and tear production..................................41
5.4: Treatments....................................................................................42
5.4.1: Lubricating drops.............................................................................................42
5.4.2: MEGs (Micro Environment Glasses)................................................................43
Section 6: Conclusion.....................................................46
Reference list................................................................48
, Abstract
Ptosis is the weakness of the upper eyelid that results in drooping in front of the ocular
surface. This can result due to several factors and it is crucial to treat to improve the
quality of life in the patient and also prevent further complications from occurring. Not
every patient with ptosis can undergo surgery due to health reasons as well as surgery
being often contraindicated. It is important to consider a non-surgical option that
minimises risks and provides satisfaction to the patient. A ptosis crutch is a safe option
that does not require surgery which attaches to the spectacle frame and elevates the
upper eyelids. This option is proven to be effective in most patients with correcting the
ptosis but complications such as comfort and dry eye can occur as result. It is in this case
that different options such as 3D printing and contact lenses have to be taken into
account. Broadening the treatment options for drooping of the eyelids is a positive step
as different correction methods can be offered to various types of patients and tailored
to their facial anatomies.
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