1)A thirty-five year old male presents to your clinic complaining, “I look old a
ID: 173537 • Letter: 1
Question
1)A thirty-five year old male presents to your clinic complaining, “I look old and my eyelids are sagging.” He also states that he sometimes feels he is wearing a hat with a big brim. He is otherwise healthy without any documented medical illness. Visual acuity is 20/20 uncorrected. Pupils are reactive to light and without afferent papillary defect. External examination is significant for bilateral ptosis: OD greater than OS. Palpebral fissure height is 6mm OD; 9mm OS. Marginal reflex distance (MRD1) is 2mm OD; which confirms your suspicion. -What is likely Diagnosis? -What medical diagnostic test can be administered to confirm suspicion? -What drug class and mechanism of action for the above pharmacological agent? -What laboratory test can you order to confirm your Diagnosis? -Will ptosis repair help this patient? Why? -What are the side effect of ptosis surgery?
Explanation / Answer
Diagnosis:
The diagnosis confirms a severe bilateral ptosis as per diagnosis MRD1 is 2mm which falls in "Severe Bilateral Ptosis"
Medical Diagnosis:
1. Hypothyroidism blood tests
Explaination: In severe hypothyroidism, bilateral droopy eyelids can also occur. one shouldn’t seek cosmetic surgery to correct the eyelid problem as once the hypothyroidism is reversed, the eyelids will resume their normal anatomical position.
2. Myasthenia gravis to be diagnosed
Explaination: A common medical disorder associated with bilateral eye ptosis or sagging eyelids is myasthenia gravis, in this medical disorder, the nerves lack a neurotransmitter that causes stimulation of the muscles.In myasthenia gravis one should not seek surgical treatment for the droopy eyelids because there are medications that can help regain normal eyelid function.
Ptosis Surgery:
The diagnosis suggests that patient has bilateral ptosis of the eyes. Patient has droopy eyelids on both sides, and then one must suspect a generalized medical disorder or aging. Bilateral eye ptosis occurs because of excess skin or fat. The excess fat causes the eyelids to sag and makes the facial appearance tired & sleepy
Ptosis surgery is done with a procedure, a local anesthesia will be used to numb your eye and the area around it.
The surgeon may only need to make a small adjustment to the lid’s lifting muscles, in severe ptosis, the levator muscle may need to be strengthened and reattached to the eyelid.
Side Effects:
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