Lacrimal sac anatomy

 

Rosenblatt is superior

Hasner is inferior

 

benefits: office vs. OR NLD probing

1. reduced anesthetic risk

2. reduced expense

3. less psychologically traumatic for child

4. parental convenience

 

Can use polytrim, sulfa, cipro (but would not use because of bone/cartilage toxicity), all about the same 80% sensitive

 

PTOSIS

congenital

third nerve palsy, horner's, myotonic (6% have marcus gunn winking jaw -

external pterygoid and levator mm, abn? innervation of V1 motor), birth trauma, blepharophimosis

 

acquired

trauma, pseudoptosis (retraction on contralateral side, double elevaator palsy), myasthenia gravis, CN III, CPO (mitochondrial problems)

 

things to assess:

levator fxn, if less than 4 mm, need sling, if greater than 4 mm, can do levator resection

upper lid margin - light reflex (nl is 4-5 mm)

palpebral fissure, should be around 9mm