ASSOCIATION OF DOUBLE ELEVATOR PALSY WITH JAW WINKING PTOSIS

Purpose: To determine the association of double elevator palsy with jaw winking ptosis. Study Design: Interventional case series. Place & Duration of Study: Mayo Hospital, Lahore between 2000 and 2003 by one surgeon. Material & Methods: Seventy patients with congenital ptosis were managed with Frontalis Fascia lata sling Surgery with or without vertical muscle surgery. Pre-operative visual acuity, margin to reflex distance in primary gaze (MRD1), margin to reflex distance in down gaze (MRD2), levator function, extra-ocular movements, bell’s phenomenon and jaw winking phenomenon were noted in all cases. Post-operative MRD1, MRD2, lagophthalmos and corneal surface were also noted. Results: Review of 70 cases with congenital ptosis showed that 8 (11%) patients had jaw winking ptosis and 10 (14%) patients had double elevator (DE) palsy. Out of these 8 patients with jaw winking ptosis, 4 (50%) patients had DE palsy. Thus 6% of the total patients had both jaw winking ptosis and DE palsy. Conclusions: This study shows that we must be very careful to eliminate double elevator palsy in cases of jaw winking ptosis due to their strong association