Aetiology of acquired blepharoptosis in young adults.

PURPOSE: To identify the causes of blepharoptosis in young adults, and explore cases that do not fit into current diagnostic categories. METHODS: A retrospective cohort study of all patients aged 18-40 years ("young adults") with acquired blepharoptosis that presented to two specialist ocular plastics practices and a paediatric ophthalmologist over a period of up to 25 years. Each patient was classified according to diagnosis. Where the diagnosis was uncertain, the files were examined in detail to try and further establish a cause. RESULTS: A total of 266 young adult patients were included. The most common causes of acquired blepharoptosis were trauma-related (28.2%) and anophthalmic blepharoptosis (19.9%). In 12.4% of the cases, a definite diagnosis could not be made. Of these, one-third had a history of soft contact lens use, a possible etiologic factor. CONCLUSIONS: The cause of acquired blepharoptosis can usually be established by an appropriate history and examination, with additional diagnostic tests sometimes required. Nearly half of all young adult ptosis is related to trauma or acquired anophthalmos. Around one in eight young adults have blepharoptosis of unknown cause, a group warranting further study.

The Posterior Approach Tarsal Switch Procedure for Myopathic Ptosis: A Modified Technique.

PURPOSE: The surgical management of myopathic ptosis remains a challenge. The authors report the results of a modified posterior approach tarsal switch technique, which raises both the upper and lower eyelids and reduces the risk of corneal exposure in these patients. METHODS: A modified tarsal switch technique is described. A tarsoconjunctival and Muller's muscle graft is harvested via a posterior approach from the upper eyelid, the defect closed, and the graft transferred to the lower eyelid. RESULTS: The procedure was performed on 16 eyelids of 9 patients. No adjunctive procedures were performed. The patients ranged in age from 36 years to 79 years. All patients had bilateral myopathic ptosis, reduced levator function, and a poor Bell's response. The margin reflex distance-1 increased by 1.5 to 4.5 mm (mean 2.3 mm) and the margin reflex distance-2 decreased by 0.5 to 2.5 mm (mean 1.6 mm). There were no intraoperative complications, no significant corneal exposure problems, and no patients required revision surgery over a follow-up period of 6 to 52 months (mean 16 months). CONCLUSIONS: This technique of harvesting the tarsoconjunctival-Muller's muscle graft posteriorly, closing that defect and transferring the graft into the lower eyelid to elevate it, is an effective surgical procedure for the management of ptosis in patients with poor ocular protective mechanisms.

How useful is visual field testing in an African glaucoma clinic?

PURPOSE: To investigate the usefulness of visual field testing in the diagnosis and subsequent management of glaucoma in a specialist glaucoma clinic at Groote Schuur Hospital, Cape Town, South Africa. METHODS: A retrospective case note review of 344 patients who attended the glaucoma clinic between January and June 2010. RESULTS: The study population consisted of 201 (58%) females and 143 (42%) males. The diagnoses included 207 (60%) cases with primary open-angle glaucoma, 58 (17%) cases with chronic angle closure glaucoma, 46 (13%) cases with secondary glaucoma, 17 (5%) cases with normal pressure glaucoma, ten (3%) cases with ocular hypertension, and six (2%) glaucoma suspects. Visual field testing contributed to the diagnosis of glaucoma in only 34 (10%) cases. A total number of 2,604 fields were performed. Of these fields, 1,931 (74%) were reliable. A baseline was reached in only 141 (53%) patients. There was evidence of field progression in only 24 (9%) cases. Changes to glaucoma treatment were based on inadequate control of intraocular pressure alone in 309 (90%) patients. Visual field progression contributed to changes in treatment in only 15 (4%) cases. CONCLUSION: Visual fields are not used in the diagnosis and management of glaucoma in the majority of patients in our clinic. Patients present with advanced disease, which is easily diagnosed without the use of visual fields. Progression of fields seldom contributes to monitoring and intraocular pressure is mainly used to monitor the adequacy of treatment.