The commoner diseases of the eye : how to detect and how to treat them . Adams Operation for Ectropion of Lower Lid. Ptosis.—Drooping of the upper lid. Itmay be congenital or acquired. Congenitalptosis is usually bilateral and is then due toeither defective development or absence of thelevator palpebral superioris. With this anomalythere are often other congenital defects. It issi mietimes hereditary. Acquired ptosis, on the other hand, usuallyaffects one side only. The commonest cause ofthis variety is paralysis of the third nerve, whichsupplies the levator palpebrae. One or moreof the ocular
The commoner diseases of the eye : how to detect and how to treat them . Adams Operation for Ectropion of Lower Lid. Ptosis.—Drooping of the upper lid. Itmay be congenital or acquired. Congenitalptosis is usually bilateral and is then due toeither defective development or absence of thelevator palpebral superioris. With this anomalythere are often other congenital defects. It issi mietimes hereditary. Acquired ptosis, on the other hand, usuallyaffects one side only. The commonest cause ofthis variety is paralysis of the third nerve, whichsupplies the levator palpebrae. One or moreof the ocular muscles supplied by the samenerve are generally paralyzed at the same time. COMMONER DISEASES OF THE EYELIDS 129 First in order of causation come thickeningand increased weight of the lid from disease(chronic conjunctival inflammation, trachoma,etc.) and, finally, wounds and adhesions of thelid to the globe (symblcpharon). Any of theseforms of ptosis may be slight; they may becomplete, in which case the lid covers the pupil. Ptosis, or Drooping of the Upper Lid. and directly interferes with vision. Attemptsare generally made by the patient to raise the lidby bringing into action the occipito-frontalismuscle, causing a wrinkling of the skin of theforehead. In the endeavor to see distinctly the 130 COMMONER DISEASES OF THE EYE patient throws the head backward, presentinga pose which is characteristic of this condition. Treatment.—When attempts to remove thecause of tin- ptosis by electricity and other ap-propriate treatment fail operative interference isinvoked. The usual method is to excise ahorizontal, oval-shaped piece of skin from thelid. How to remove enough skin so that theshortening of the lid may allow of vision, andyet not so much as to prevent closure of the eyeduring sleep, is the problem. A preliminary observation should be made bypinching up the palpebral skin with a pair ofsuitable forceps. The skin so grasped by theptosis forceps is cut off by one sweep of a s
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