The extraocular and eyelid muscles can become dysfunctional either due to derangement of nerve supply or due to muscle disease itself. So scientifically when a patient presents with dysfunctional muscle in this area our first step should be to find out whether it is due to neuropathy or due to myopathy. But in routine clinical practice it has been observed that most of the ophthalmologists across the world take it fore granted that this is due to nerve problem.
Ref: Shah SIA et al: Concise Ophthalmology Text & Atals. 5th ed. Param B (Pvt.) Ltd. 2018: 26-27
This practice may be because of two reasons 1. Neurogenic problem is more common so its easy to presume it as neurogenic 2. Its bothersome to investigate it at the beginning when we know that the result will be the same (our clinical diagnosis) in more than 90% of cases. But it seems misunderstood e.g if the problem is due to a muscle disease e.g. myotonic dystrophy, just knowing the state of serum enzyme levels will help a lot in inclusion or exclusion of the basic problem (i.e. neuropathy or myopathy).
Comprehensive exam will be conducted by neuro-ophthalmologist
A thorough diagnostic evaluation is recommended, which should include evaluation for neurologic and muscular differential diagnoses
So neuro-ophthalmologist should be involved in management of ptosis Marianne Levon Shahsuvaryan ?
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