Text-book of ophthalmology . osed condition, so that the upper lid rises abnormally high. [This occurs not onlyin central oculo-motor paralysis, but also in peripheral paralyses of the eye muscles,including especially congenital paralysis of the external rectus due to actual deficiencythe muscle. In this latter set of cases, and rarely in some of the others, the ptosis 692 TEXT-BOOK OF OPHTHALMOLOGY occurs in adduction, not in abduction. In some of these cases, at any rate, it is not atrue ptosis that is in question, but a contraction of the orbicularis, marked by a sink-ing of the upper and a
Text-book of ophthalmology . osed condition, so that the upper lid rises abnormally high. [This occurs not onlyin central oculo-motor paralysis, but also in peripheral paralyses of the eye muscles,including especially congenital paralysis of the external rectus due to actual deficiencythe muscle. In this latter set of cases, and rarely in some of the others, the ptosis 692 TEXT-BOOK OF OPHTHALMOLOGY occurs in adduction, not in abduction. In some of these cases, at any rate, it is not atrue ptosis that is in question, but a contraction of the orbicularis, marked by a sink-ing of the upper and a rising of the lower lid. There are also cases of cyclic wideningand narrowing of the palpebral fissure, the widening, which is evidently due to spasticcontraction of the levator, being associated with convergence of the eyes and miosis(Von Hippel).—D.] There is a sort of ptosis that develops without known cause in women (very rarelyin men) of middle age. It is always bilateral, and sets in so gradually that not till after. Fig. 292.—Left-sided ptosis was not complete, but just great enough for the upper lid to cover the pupil. Nowas the left eye was the better of the two, the patient, in order to see with it. lifted his lid by contract-ing the frontalis muscle. He was not able, however, to do this on the left side alone, but wrinkled hisforehead all over, so that the eyebrows are elevated on both sides. Hence, too, the right upper lid isdrawn unusually high up, so that a srrip of sclera can be seen exposed above the cornea, and the dif-ference between the two palpebral fissures has become even more striking than before. The pupil ofthe right, amblyopic eye is dilated, a series of years is it pronounced enough to cause any considerable interference withvision. In these cases it is not a paralysis of the nerve, but a primary atrophy of themuscle itself that is present (ptosis myopthica). Mechanical means have been recommended for lifting the lid in ptosis, includi
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