{"id":3983,"date":"2021-04-10T10:16:09","date_gmt":"2021-04-10T13:16:09","guid":{"rendered":"https:\/\/clinicamariomonteiro.com.br\/site\/?p=3983"},"modified":"2023-07-12T09:05:29","modified_gmt":"2023-07-12T12:05:29","slug":"diagnostico-diferencial-das-ptoses-palpebrais","status":"publish","type":"post","link":"https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/","title":{"rendered":"Diagn\u00f3stico Diferencial das Ptoses Palpebrais"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-6ez6tf-3bd3fdea63b8133f7837dee7431a3a7b\">\n#top .flex_column.av-6ez6tf-3bd3fdea63b8133f7837dee7431a3a7b{\nmargin-top:0px;\nmargin-bottom:0px;\n}\n.flex_column.av-6ez6tf-3bd3fdea63b8133f7837dee7431a3a7b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-6ez6tf-3bd3fdea63b8133f7837dee7431a3a7b{\nmargin-top:0px;\nmargin-bottom:0px;\n}\n<\/style>\n<div  class='flex_column av-6ez6tf-3bd3fdea63b8133f7837dee7431a3a7b av_one_full  avia-builder-el-0  el_before_av_one_full  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kcf91zjo-de72d3d20467d2d56b76b04c26b6c9bf\">\n#top .av-special-heading.av-kcf91zjo-de72d3d20467d2d56b76b04c26b6c9bf{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-kcf91zjo-de72d3d20467d2d56b76b04c26b6c9bf .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-kcf91zjo-de72d3d20467d2d56b76b04c26b6c9bf .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-kcf91zjo-de72d3d20467d2d56b76b04c26b6c9bf av-special-heading-h2 blockquote modern-quote  avia-builder-el-1  el_before_av_hr  avia-builder-el-first '><h2 class='av-special-heading-tag '  itemprop=\"headline\"  >Diagn\u00f3stico Diferencial das Ptoses Palpebrais<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kbtmc7wh-532c119224e0a4ac385862389d429780\">\n#top .hr.av-kbtmc7wh-532c119224e0a4ac385862389d429780{\nmargin-top:0;\nmargin-bottom:0;\n}\n.hr.av-kbtmc7wh-532c119224e0a4ac385862389d429780 .hr-inner{\nwidth:100%;\nborder-color:#cccacc;\n}\n<\/style>\n<div  class='hr av-kbtmc7wh-532c119224e0a4ac385862389d429780 hr-custom  avia-builder-el-2  el_after_av_heading  avia-builder-el-last  hr-center hr-icon-no'><span class='hr-inner inner-border-av-border-thin'><span class=\"hr-inner-style\"><\/span><\/span><\/div><\/p><\/div>\n<div class='flex_column_table av-8ry69v-c2726188a652efa39671da8afa721344 sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-8ry69v-c2726188a652efa39671da8afa721344\">\n#top .flex_column_table.av-equal-height-column-flextable.av-8ry69v-c2726188a652efa39671da8afa721344{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-8ry69v-c2726188a652efa39671da8afa721344{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-8ry69v-c2726188a652efa39671da8afa721344 av_one_full  avia-builder-el-3  el_after_av_one_full  el_before_av_one_full  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-4tp1f-a0af497f978e05dd9c17b74fdd7238af\">\n#top .av-special-heading.av-4tp1f-a0af497f978e05dd9c17b74fdd7238af{\nmargin:25px 0 0 0;\npadding-bottom:10px;\n}\nbody .av-special-heading.av-4tp1f-a0af497f978e05dd9c17b74fdd7238af .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-4tp1f-a0af497f978e05dd9c17b74fdd7238af .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-4tp1f-a0af497f978e05dd9c17b74fdd7238af av-special-heading-h3 blockquote modern-quote  avia-builder-el-4  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >Introdu\u00e7\u00e3o<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-nms2n-fc171d3a0e02f8c9b230d66cee0db3c4\">\n.flex_column.av-nms2n-fc171d3a0e02f8c9b230d66cee0db3c4{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-nms2n-fc171d3a0e02f8c9b230d66cee0db3c4 av_one_full  avia-builder-el-5  el_after_av_one_full  el_before_av_one_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kbtmaahr-ef6d5c5feaa31ae2efd1b01248110ccd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Ptose palpebral ou blefaroptose \u00e9 a condi\u00e7\u00e3o em que a margem da p\u00e1lpebra superior est\u00e1 situada em um n\u00edvel mais baixo que o normal, na posi\u00e7\u00e3o prim\u00e1ria do olhar, cobrindo mais do que 2 mm superiores da c\u00f3rnea<\/span><span data-contrast=\"auto\"> (Figura 1)<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\"> Pode ser causada por in\u00fameras condi\u00e7\u00f5es neurol\u00f3gicas e neuromusculares al\u00e9m de processos locais e anomalias cong\u00eanitas.<\/span><span data-ccp-props=\"{&quot;201341983&quot;:0,&quot;335551550&quot;:6,&quot;335551620&quot;:6,&quot;335559731&quot;:851,&quot;335559739&quot;:0,&quot;335559740&quot;:480}\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-9dri9r-5e855fdb244d5a87869fcb381fec937d\">\n.flex_column.av-9dri9r-5e855fdb244d5a87869fcb381fec937d{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-9dri9r-5e855fdb244d5a87869fcb381fec937d av_one_fifth  avia-builder-el-7  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-7an8hf-533077beba4c94443ecc1c74ba4b2be0\">\n.flex_column.av-7an8hf-533077beba4c94443ecc1c74ba4b2be0{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-7an8hf-533077beba4c94443ecc1c74ba4b2be0 av_three_fifth  avia-builder-el-8  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kc0rgk0f-fda86ac6dce2fca64010a912f8ff6968\">\n.avia-image-container.av-kc0rgk0f-fda86ac6dce2fca64010a912f8ff6968 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-kc0rgk0f-fda86ac6dce2fca64010a912f8ff6968 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-kc0rgk0f-fda86ac6dce2fca64010a912f8ff6968 av-styling- avia-align-center  avia-builder-el-9  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4001 avia-img-lazy-loading-not-4001 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-1.jpg\" alt='Ptose a esquerda, s\u00edndrome de Horner cong\u00eanita' title='Ptose a esquerda, s\u00edndrome de Horner cong\u00eanita'  height=\"453\" width=\"950\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-1.jpg 950w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-1-300x143.jpg 300w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-1-768x366.jpg 768w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-1-705x336.jpg 705w\" sizes=\"(max-width: 950px) 100vw, 950px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kcl25q1i-85ebd06ad1ded363cf31392d8598f9e1 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 1 \u2013 Ptose a esquerda, s\u00edndrome de Horner cong\u00eanita<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n<div class='flex_column_table av-8ry69v-c2726188a652efa39671da8afa721344 sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-8ry69v-c2726188a652efa39671da8afa721344\">\n#top .flex_column_table.av-equal-height-column-flextable.av-8ry69v-c2726188a652efa39671da8afa721344{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-8ry69v-c2726188a652efa39671da8afa721344{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-8ry69v-c2726188a652efa39671da8afa721344 av_one_full  avia-builder-el-11  el_after_av_three_fifth  el_before_av_one_full  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  '     ><section  class='av_textblock_section av-kbtmaahr-ef6d5c5feaa31ae2efd1b01248110ccd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Antes de discutir o diagn\u00f3stico diferencial das ptoses \u00e9 importante tecer algumas considera\u00e7\u00f5es anat\u00f4micas e fisiol\u00f3gicas importantes. A fenda palpebral mede em torno de 9 a 10 mm no adulto e \u00e9 determinada pela intera\u00e7\u00e3o dos m\u00fasculos que abrem e daqueles que fecham as p\u00e1lpebras. A abertura da p\u00e1lpebra \u00e9 feita pelo elevador palpebral auxiliado por dois m\u00fasculos acess\u00f3rios, o m\u00fasculo de Muller e o m\u00fasculo frontal. O elevador da p\u00e1lpebra \u00e9 inervado pelo oculomotor, com fibras que se originam no subn\u00facleo do mesmo<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-contrast=\"auto\"> que est\u00e1 situado <\/span><span data-contrast=\"auto\">caudalmente<\/span><span data-contrast=\"auto\"> no n\u00facleo do oculomotor<\/span><span data-contrast=\"auto\"> no mesenc\u00e9falo<\/span><span data-contrast=\"auto\">.<\/span><\/p>\n<p><span data-contrast=\"auto\">As fibras seguem <\/span><span data-contrast=\"auto\">pelo nervo oculomotor e ao n\u00edvel do seio cavernoso prosseguem pela sua divis\u00e3o superior. O subn\u00facleo do elevador sofre influ\u00eancia de <\/span><b><span data-contrast=\"auto\">controles <\/span><\/b><b><span data-contrast=\"auto\">supranucleares<\/span><\/b><span data-contrast=\"auto\"> que se localizam nos lobos frontais, no giro angular e no lobo temporal. Estes controles explicam <\/span><span data-contrast=\"auto\">por que<\/span><span data-contrast=\"auto\"> as p\u00e1lpebras ficam mais ou menos abertas dependendo do estado de alerta. Quando se olha atentamente a algo as p\u00e1lpebras chegam a abrir at\u00e9 2<\/span> <span data-contrast=\"auto\">mm e ao contr\u00e1rio quando se est\u00e1 sonolento elas caem.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">No entanto, na sua maior parte a influ\u00eancia <\/span><span data-contrast=\"auto\">inervacional<\/span><span data-contrast=\"auto\"> sobre o subn\u00facleo do oculomotor destinado ao elevador da p\u00e1lpebra se faz por controle reflexos mais baixos. Um dos reflexos mais b\u00e1sicos \u00e9 a coordena\u00e7\u00e3o do controle das p\u00e1lpebras <\/span><b><span data-contrast=\"auto\">um com o outro<\/span><\/b><span data-contrast=\"auto\">. Todos os movimentos de uma e outra p\u00e1lpebra no indiv\u00edduo normal, s\u00e3o virtualmente id\u00eanticos. Al\u00e9m disso, a inerva\u00e7\u00e3o sim\u00e9trica dos dois olhos atrav\u00e9s da <\/span><b><span data-contrast=\"auto\">lei de Hering<\/span><\/b><span data-contrast=\"auto\"> tamb\u00e9m funciona nas p\u00e1lpebras. Quando um olho apresenta ptose, o contralateral se retrai na tentativa de melhorar. Se corrigirmos a ptose, a retra\u00e7\u00e3o palpebral desaparece.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A atividade do elevador da p\u00e1lpebra \u00e9 ligada diretamente \u00e0 dos outros m\u00fasculos extraoculares. Um <\/span><b><span data-contrast=\"auto\">t\u00f4nus<\/span><\/b> <b><span data-contrast=\"auto\">inervacional<\/span><\/b> <span data-contrast=\"auto\">semelhante entre o elevador da p\u00e1lpebra e o reto superior existe. Quando se olha para cima os dois s\u00e3o inervados. Quando se olha para baixo os dois s\u00e3o inibidos, at\u00e9 a inibi\u00e7\u00e3o m\u00e1xima na parte inferior. Uma rela\u00e7\u00e3o inversa de inerva\u00e7\u00e3o entre o reto superior e o oculomotor existe quando se fecha a p\u00e1lpebra com for\u00e7a ou durante o sono.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Parece tamb\u00e9m haver uma pequena sincronia entre o elevador da p\u00e1lpebra e os m\u00fasculos horizontais. J\u00e1 se observou atividade do elevador em abdu\u00e7\u00e3o e adu\u00e7\u00e3o em uma certa porcentagem de indiv\u00edduos. H\u00e1 tamb\u00e9m uma sincinesia entre o elevador da p\u00e1lpebra e a abertura da boca. Muitos indiv\u00edduos quando solicitamos para abrir os olhos abrem a boca, e vice versa. Com rela\u00e7\u00e3o a sincinesia entre elevador e <\/span><span data-contrast=\"auto\">orbicularis<\/span><span data-contrast=\"auto\">, observamos que <\/span><span data-contrast=\"auto\">durante o piscar volunt\u00e1rio ou peri\u00f3dico o <\/span><span data-contrast=\"auto\">t\u00f4nus<\/span><span data-contrast=\"auto\"> do elevador se extingue ao passo que o <\/span><span data-contrast=\"auto\">orbicularis<\/span><span data-contrast=\"auto\"> contrai.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23tuab-683166cf6e154c6f3183ddd3f10d0abf\">\n#top .flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-23tuab-683166cf6e154c6f3183ddd3f10d0abf av_one_full  avia-builder-el-13  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-40nzlv-00324523878fe1d8fea7daaa7f14d1a5\">\n#top .av-special-heading.av-40nzlv-00324523878fe1d8fea7daaa7f14d1a5{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-40nzlv-00324523878fe1d8fea7daaa7f14d1a5 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-40nzlv-00324523878fe1d8fea7daaa7f14d1a5 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-40nzlv-00324523878fe1d8fea7daaa7f14d1a5 av-special-heading-h3 blockquote modern-quote  avia-builder-el-14  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >PSEUDO PTOSE PALPEBRAL <\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n<div class='flex_column_table av-svw7ov-849604bd6984f3c91577d6f3d2f0fd5b sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-svw7ov-849604bd6984f3c91577d6f3d2f0fd5b\">\n#top .flex_column_table.av-equal-height-column-flextable.av-svw7ov-849604bd6984f3c91577d6f3d2f0fd5b{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-svw7ov-849604bd6984f3c91577d6f3d2f0fd5b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-svw7ov-849604bd6984f3c91577d6f3d2f0fd5b av_one_full  avia-builder-el-15  el_after_av_one_full  el_before_av_one_fifth  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kbtmaahr-ef6d5c5feaa31ae2efd1b01248110ccd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">\u00c9 importante considerar que diversas condi\u00e7\u00f5es podem simular uma ptose palpebral. O termo <\/span><b><span data-contrast=\"auto\">pseudoptose<\/span><\/b><span data-contrast=\"auto\"> se refere a uma aparente ptose n\u00e3o relacionada com altera\u00e7\u00f5es neurais, miop\u00e1ticas ou neuromusculares. <\/span><span data-contrast=\"auto\">Pseudoptose<\/span><span data-contrast=\"auto\"> pode ocorre no lado de um olho que \u00e9 anormal no seu tamanho, forma ou posi\u00e7\u00e3o.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Uma das causas mais importantes de <\/span><span data-contrast=\"auto\">pseudoptose<\/span><span data-contrast=\"auto\"> \u00e9 a exist\u00eancia de <\/span><b><span data-contrast=\"auto\">estrabismo vertical<\/span><\/b><span data-contrast=\"auto\"> (Figura 2).<\/span><span data-contrast=\"auto\"> Quando um olho se situa abaixo do outro, a p\u00e1lpebra do olho <\/span><span data-contrast=\"auto\">hipotr\u00f3pico<\/span><span data-contrast=\"auto\"> acompanha o mesmo de tal forma que se posiciona tamb\u00e9m abaixo do n\u00edvel do olho normal contralateral simulando uma ptose. A simples oclus\u00e3o do olho normal permite o diagn\u00f3stico uma vez que o olho <\/span><span data-contrast=\"auto\">hipotr\u00f3pico<\/span><span data-contrast=\"auto\"> se eleva normalizando a posi\u00e7\u00e3o da p\u00e1lpebra.\u00a0 <\/span><span data-contrast=\"auto\">Pseudoptose<\/span><span data-contrast=\"auto\"> pode ocorrer tamb\u00e9m por falta de suporte do globo ocular para a p\u00e1lpebra no <\/span><b><span data-contrast=\"auto\">enoftalmo<\/span><\/b><span data-contrast=\"auto\">, na <\/span><b><span data-contrast=\"auto\">microftalmia<\/span><\/b><span data-contrast=\"auto\"> cong\u00eanita e na<\/span><b><span data-contrast=\"auto\"> atrofia do globo ocular<\/span><\/b><span data-contrast=\"auto\">. O <\/span><span data-contrast=\"auto\">enoftalmo<\/span><span data-contrast=\"auto\"> pode ocorrer em casos de atrofia da gordura orbit\u00e1ria e fraturas de assoalho da \u00f3rbita e at\u00e9 na s\u00edndrome de <\/span><span data-contrast=\"auto\">Duane<\/span><span data-contrast=\"auto\">. Nesta s\u00edndrome quando ocorre adu\u00e7\u00e3o do olho existe uma <\/span><span data-contrast=\"auto\">co-contra\u00e7\u00e3o<\/span><span data-contrast=\"auto\"> dos m\u00fasculos retos medial e reto lateral (por anomalia <\/span><span data-contrast=\"auto\">inervacional<\/span><span data-contrast=\"auto\">) levando a <\/span><span data-contrast=\"auto\">enoftalmo<\/span><span data-contrast=\"auto\"> e queda da p\u00e1lpebra por falta de suporte do globo ocular.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-77ad0v-7d276c370ab52c05c855713901ef169a\">\n.flex_column.av-77ad0v-7d276c370ab52c05c855713901ef169a{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-77ad0v-7d276c370ab52c05c855713901ef169a av_one_fifth  avia-builder-el-17  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-qum6jz-c32eeb6800bc6749bea343acd3581a7f\">\n.flex_column.av-qum6jz-c32eeb6800bc6749bea343acd3581a7f{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-qum6jz-c32eeb6800bc6749bea343acd3581a7f av_three_fifth  avia-builder-el-18  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-p5ayof-64f003fc8f1c762a4f79539e50afe834\">\n.avia-image-container.av-p5ayof-64f003fc8f1c762a4f79539e50afe834 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-p5ayof-64f003fc8f1c762a4f79539e50afe834 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-p5ayof-64f003fc8f1c762a4f79539e50afe834 av-styling- avia-align-center  avia-builder-el-19  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4007 avia-img-lazy-loading-not-4007 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-2.jpg\" alt='Pseudo ptose por estrabismo vertical a direita' title='Pseudo ptose por estrabismo vertical a direita'  height=\"269\" width=\"645\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-2.jpg 645w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-2-300x125.jpg 300w\" sizes=\"(max-width: 645px) 100vw, 645px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kn5etv8t-d2357ffc8670f69273dd475ff50e478b '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 2 \u2013 Pseudoptose por estrabismo vertical a direita. Observe tamb\u00e9m proptose daquele olho decorrente de tumor orbit\u00e1rio<\/strong><\/p>\n<\/div><\/section><\/p><\/div><div class='flex_column_table av-nnwt5b-de3b56f192d5772f5485e1d12673f37a sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-nnwt5b-de3b56f192d5772f5485e1d12673f37a\">\n#top .flex_column_table.av-equal-height-column-flextable.av-nnwt5b-de3b56f192d5772f5485e1d12673f37a{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-nnwt5b-de3b56f192d5772f5485e1d12673f37a{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-nnwt5b-de3b56f192d5772f5485e1d12673f37a av_one_full  avia-builder-el-21  el_after_av_three_fifth  el_before_av_one_half  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  '     ><section  class='av_textblock_section av-kn5ewpys-868c6f0ebb1aa496eafe84fe4f2e5f3a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><b><span data-contrast=\"auto\">Dermatoc\u00e1lase<\/span><\/b><span data-contrast=\"auto\"> \u00e9 um achado comum que tamb\u00e9m pode simular ou mesmo mascarar uma ptose<\/span><span data-contrast=\"auto\"> (Figura 3)<\/span><span data-contrast=\"auto\">. Esta condi\u00e7\u00e3o resulta de um excesso de pele na p\u00e1lpebra superior que leva a mesma a se dobrar sobre a margem palpebral. Da mesma forma, o edema palpebral em processo inflamat\u00f3rios da p\u00e1lpebra ou mesmo da conjuntiva tarsal superior pode simular uma ptose. <\/span><span data-contrast=\"auto\">Pseudo-ptose<\/span><span data-contrast=\"auto\"> pode tamb\u00e9m originar de <\/span><b><span data-contrast=\"auto\">hiperatividade involunt\u00e1ria do m\u00fasculo <\/span><\/b><b><span data-contrast=\"auto\">orbicularis<\/span><\/b><span data-contrast=\"auto\">. Quando est\u00e1 presente em apenas um lado, uma irrita\u00e7\u00e3o local deve ser suspeitada, como por exemplo uma ceratite ou um corpo estranho. Da mesma forma pode ocorrer em quadros iniciais de <\/span><span data-contrast=\"auto\">blefaroespasmo<\/span><span data-contrast=\"auto\"> que podem ser confundidos com a ptose decorrente de miastenia gravis. A hiperatividade do <\/span><span data-contrast=\"auto\">orbicularis<\/span><span data-contrast=\"auto\"> pode tamb\u00e9m ser volunt\u00e1ria em casos de <\/span><span data-contrast=\"auto\">pseudo-ptose<\/span> <b><span data-contrast=\"auto\">funcional<\/span><\/b><span data-contrast=\"auto\"> (Figura 4<\/span><span data-contrast=\"auto\">).<\/span><span data-contrast=\"auto\">\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lsatov-158339983018957f518fafb2c506eb5c\">\n.flex_column.av-lsatov-158339983018957f518fafb2c506eb5c{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-lsatov-158339983018957f518fafb2c506eb5c av_one_half  avia-builder-el-23  el_after_av_one_full  el_before_av_one_half  first flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kfckbz-f14a8253f9fd33582ffb2768765b9263\">\n.avia-image-container.av-kfckbz-f14a8253f9fd33582ffb2768765b9263 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-kfckbz-f14a8253f9fd33582ffb2768765b9263 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-kfckbz-f14a8253f9fd33582ffb2768765b9263 av-styling- avia-align-center  avia-builder-el-24  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4008 avia-img-lazy-loading-not-4008 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-3.jpg\" alt='' title='Dermatocalaze bilateral'  height=\"223\" width=\"532\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-3.jpg 532w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-3-300x126.jpg 300w\" sizes=\"(max-width: 532px) 100vw, 532px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kn5f407f-0e4e648f6318b312a81ef5fa75b1f823 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 3. Dermatocalaze bilateral<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-i61e8v-5dd30ee5b464cfbe3fb78f0ee6ffe3a1\">\n.flex_column.av-i61e8v-5dd30ee5b464cfbe3fb78f0ee6ffe3a1{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-i61e8v-5dd30ee5b464cfbe3fb78f0ee6ffe3a1 av_one_half  avia-builder-el-26  el_after_av_one_half  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-f8b8n3-677b932699ebb112c17c2e2fdd921bd1\">\n.avia-image-container.av-f8b8n3-677b932699ebb112c17c2e2fdd921bd1 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-f8b8n3-677b932699ebb112c17c2e2fdd921bd1 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-f8b8n3-677b932699ebb112c17c2e2fdd921bd1 av-styling- avia-align-center  avia-builder-el-27  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4009 avia-img-lazy-loading-not-4009 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-4.jpg\" alt='' title='Pseudoptose a direita por hiperatividade volunt\u00e1ria do orbicularis.'  height=\"237\" width=\"532\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-4.jpg 532w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-4-300x134.jpg 300w\" sizes=\"(max-width: 532px) 100vw, 532px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kn5f4dvb-0918bd513b5dcd76616e1524dd681c32 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 4. Pseudoptose a direita por hiperatividade volunt\u00e1ria do orbicularis. Observe o abaixamento dos superc\u00edlios a direita evidenciando a contra\u00e7\u00e3o muscular<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n<div class='flex_column_table av-etvh7z-1ab07dc2dbcf2fdb0ce6443819af4483 sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-etvh7z-1ab07dc2dbcf2fdb0ce6443819af4483\">\n#top .flex_column_table.av-equal-height-column-flextable.av-etvh7z-1ab07dc2dbcf2fdb0ce6443819af4483{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-etvh7z-1ab07dc2dbcf2fdb0ce6443819af4483{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-etvh7z-1ab07dc2dbcf2fdb0ce6443819af4483 av_one_full  avia-builder-el-29  el_after_av_one_half  el_before_av_one_fifth  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kn5f5lpm-d53a4cf964d71fec623f6a69d47de3b9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Outras considera\u00e7\u00f5es importantes no diagn\u00f3stico diferencial das ptoses s\u00e3o a retra\u00e7\u00e3o palpebral ou exoftalmia no olho contralateral. Nos dois casos, dependendo da conforma\u00e7\u00e3o facial e do aspecto pr\u00e9vio do paciente pode existir confus\u00e3o, quando se considera a p\u00e1lpebra normal como apresentando ptose, pela compara\u00e7\u00e3o com o olho contralateral anormal. Por fim devemos lembrar como causas de <\/span><span data-contrast=\"auto\">pseudoptose<\/span><span data-contrast=\"auto\"> o <\/span><span data-contrast=\"auto\">epicanto<\/span><span data-contrast=\"auto\">, a assimetria facial e a atrofia de gordura da p\u00e1lpebra superior levando a eleva\u00e7\u00e3o do sulco <\/span><span data-contrast=\"auto\">orbitopalpebral<\/span><span data-contrast=\"auto\">.<\/span><span data-contrast=\"auto\"> Inclui-se ainda nesse grupo pacientes com distopias oculares provocadas por les\u00f5es orbit\u00e1rias que ao deslocar o olho para cima (tumores situados inferiormente) fazem com que a p\u00e1lpebra cubra mais que 2mm da c\u00f3rnea levando \u00e0 apar\u00eancia de \u201cptose\u201d (Figura <\/span><span data-contrast=\"auto\">5<\/span><span data-contrast=\"auto\">).\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{\">Exclu\u00eddas as causas de pseudoptose devemos dividir as ptoses verdadeiras em: cong\u00eanita e adquirida.\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-57i4m7-46d3489452cffcd907432754c24646f6\">\n.flex_column.av-57i4m7-46d3489452cffcd907432754c24646f6{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-57i4m7-46d3489452cffcd907432754c24646f6 av_one_fifth  avia-builder-el-31  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-c36vpb-629c66f6e33682567aeb10aaf8e7369b\">\n.flex_column.av-c36vpb-629c66f6e33682567aeb10aaf8e7369b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-c36vpb-629c66f6e33682567aeb10aaf8e7369b av_three_fifth  avia-builder-el-32  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-13s9pr-798fc9d8ec938426c6f43de1db3878ba\">\n.avia-image-container.av-13s9pr-798fc9d8ec938426c6f43de1db3878ba img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-13s9pr-798fc9d8ec938426c6f43de1db3878ba .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-13s9pr-798fc9d8ec938426c6f43de1db3878ba av-styling- avia-align-center  avia-builder-el-33  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4011 avia-img-lazy-loading-not-4011 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-5.jpg\" alt='Tumor orbit\u00e1rio (hemangioma)' title='Tumor orbit\u00e1rio (hemangioma)'  height=\"201\" width=\"532\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-5.jpg 532w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-5-300x113.jpg 300w\" sizes=\"(max-width: 532px) 100vw, 532px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kn5f6ysr-dc191f60c929e7f0dcf5113bbe4cb90a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 5. Tumor orbit\u00e1rio (hemangioma) situado inferiormente esquerda levando ao deslocamento ocular para cima e pseudoptose palpebral esquerda<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-9oodsf-9af5a57842114829d18c79362568ffa1\">\n#top .flex_column.av-9oodsf-9af5a57842114829d18c79362568ffa1{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-9oodsf-9af5a57842114829d18c79362568ffa1{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-9oodsf-9af5a57842114829d18c79362568ffa1{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-9oodsf-9af5a57842114829d18c79362568ffa1 av_one_full  avia-builder-el-35  el_after_av_three_fifth  el_before_av_one_full  first flex_column_div av-zero-column-padding  '     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kn5fk2fr-bb963555b4aef254eb4df232b0dae4a8\">\n#top .av-special-heading.av-kn5fk2fr-bb963555b4aef254eb4df232b0dae4a8{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-kn5fk2fr-bb963555b4aef254eb4df232b0dae4a8 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-kn5fk2fr-bb963555b4aef254eb4df232b0dae4a8 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-kn5fk2fr-bb963555b4aef254eb4df232b0dae4a8 av-special-heading-h3 blockquote modern-quote  avia-builder-el-36  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >PTOSE PALPEBRAL CONG\u00caNITA <\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n<div class='flex_column_table av-6xeztb-85ad00254fe95de632fbfc00b00cbc22 sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-6xeztb-85ad00254fe95de632fbfc00b00cbc22\">\n#top .flex_column_table.av-equal-height-column-flextable.av-6xeztb-85ad00254fe95de632fbfc00b00cbc22{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-6xeztb-85ad00254fe95de632fbfc00b00cbc22{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-6xeztb-85ad00254fe95de632fbfc00b00cbc22 av_one_full  avia-builder-el-37  el_after_av_one_full  el_before_av_one_fifth  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kn5fkd8i-63a7511ba5c80f0b1d752fada102e0df '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Esta \u00e9 a anomalia palpebral mais comum. Embora ocasionalmente a ptose cong\u00eanita seja neurop\u00e1tica como em pacientes com paralisia oculomotora ou s\u00edndrome de <\/span><span data-contrast=\"auto\">Horner<\/span><span data-contrast=\"auto\"> cong\u00eanita<\/span><span data-contrast=\"auto\"> (Figura 1)<\/span><span data-contrast=\"auto\">, na grande maioria dos casos, a ptose cong\u00eanita \u00e9 <\/span><span data-contrast=\"auto\">miop\u00e1tica<\/span><span data-contrast=\"auto\">, causada por falta de desenvolvimento do m\u00fasculo elevador da p\u00e1lpebra e seu tend\u00e3o.<\/span><span data-contrast=\"auto\"> (Figura 6)<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A ptose cong\u00eanita responde por 60 a 70% das ptoses e \u00e9 bilateral em 25% dos casos. Pode ser uma anomalia isolada ou associada a outros defeitos como <\/span><span data-contrast=\"auto\">epicanto<\/span><span data-contrast=\"auto\">, anormalidades do ponto lacrimal, catarata cong\u00eanita, <\/span><span data-contrast=\"auto\">anisometropia<\/span><span data-contrast=\"auto\"> e particularmente estrabismo e ambliopia. Defeitos sist\u00eamicos como altera\u00e7\u00f5es esquel\u00e9ticas e auditivas podem tamb\u00e9m se associar a ptose cong\u00eanita.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-4db8j3-2da342321ceabdd6bce142b73d8308cc\">\n.flex_column.av-4db8j3-2da342321ceabdd6bce142b73d8308cc{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-4db8j3-2da342321ceabdd6bce142b73d8308cc av_one_fifth  avia-builder-el-39  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-554e73-5e53114beafc620513c6646883006eff\">\n.flex_column.av-554e73-5e53114beafc620513c6646883006eff{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-554e73-5e53114beafc620513c6646883006eff av_three_fifth  avia-builder-el-40  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3uwxxr-3c22dbe873c462ae85c568b5f37aeeb5\">\n.avia-image-container.av-3uwxxr-3c22dbe873c462ae85c568b5f37aeeb5 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-3uwxxr-3c22dbe873c462ae85c568b5f37aeeb5 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-3uwxxr-3c22dbe873c462ae85c568b5f37aeeb5 av-styling- avia-align-center  avia-builder-el-41  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4012 avia-img-lazy-loading-not-4012 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-6.jpg\" alt='Ptose cong\u00eanita' title='Ptose cong\u00eanita'  height=\"213\" width=\"561\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-6.jpg 561w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-6-300x114.jpg 300w\" sizes=\"(max-width: 561px) 100vw, 561px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kn5fkqfs-cbca71e633b8db9243aaeeae03d03706 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 6. Ptose cong\u00eanita<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n<div class='flex_column_table av-29ngz3-a13e5eefbada9870e92a84751d16816b sc-av_one_full av-equal-height-column-flextable'>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-29ngz3-a13e5eefbada9870e92a84751d16816b\">\n#top .flex_column_table.av-equal-height-column-flextable.av-29ngz3-a13e5eefbada9870e92a84751d16816b{\nmargin-top:12px;\nmargin-bottom:0px;\n}\n.flex_column.av-29ngz3-a13e5eefbada9870e92a84751d16816b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-29ngz3-a13e5eefbada9870e92a84751d16816b av_one_full  avia-builder-el-43  el_after_av_three_fifth  el_before_av_one_full  first flex_column_table_cell av-equal-height-column av-align-top av-zero-column-padding  '     ><section  class='av_textblock_section av-kn5fmx55-d84b3a3fc459207418cd72a1aefd548e '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">A ptose cong\u00eanita <\/span><span data-contrast=\"auto\">freq\u00fcentemente<\/span><span data-contrast=\"auto\"> se associa a limita\u00e7\u00e3o da eleva\u00e7\u00e3o do olho acometido. A severidade da ptose varia bastante entre os indiv\u00edduos afetados. Em alguns casos a ptose \u00e9 muito discreta enquanto que em outros \u00e9 muito severa levando \u00e0 baixa visual e eleva\u00e7\u00e3o do queixo do paciente na tentativa de posicionar o eixo visual na fenda palpebral. Na maioria dos casos a ptose se mant\u00e9m estacion\u00e1ria ao longo da vida. Nos casos mais severos com risco de ambliopia ou naqueles esteticamente ruins a cirurgia corretiva se mostra indicada.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A diferencia\u00e7\u00e3o com outras formas de ptose se faz pela anamnese cuidadosa, observa\u00e7\u00e3o de fotos antigas e a observa\u00e7\u00e3o de que n\u00e3o existe evid\u00eancia de comprometimento pupilar ou de outros m\u00fasculos inervados pelo oculomotor a n\u00e3o ser o reto superior, que muitas vezes se mostra acometido juntamente com a ptose.\u00a0<\/span><\/p>\n<\/div><\/section><\/div><\/div><!--close column table wrapper. Autoclose: 1 -->\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23tuab-8a4b8c832ccf344b6e611cd3c035ad44\">\n#top .flex_column.av-23tuab-8a4b8c832ccf344b6e611cd3c035ad44{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-23tuab-8a4b8c832ccf344b6e611cd3c035ad44{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-23tuab-8a4b8c832ccf344b6e611cd3c035ad44{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-23tuab-8a4b8c832ccf344b6e611cd3c035ad44 av_one_full  avia-builder-el-45  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kcl2k55j-dca3645dea005cf534f4fa61ad2a547c\">\n#top .av-special-heading.av-kcl2k55j-dca3645dea005cf534f4fa61ad2a547c{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-kcl2k55j-dca3645dea005cf534f4fa61ad2a547c .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-kcl2k55j-dca3645dea005cf534f4fa61ad2a547c .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-kcl2k55j-dca3645dea005cf534f4fa61ad2a547c av-special-heading-h3 blockquote modern-quote  avia-builder-el-46  avia-builder-el-no-sibling '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >PTOSE PALPEBRAL ADQUIRIDA <\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23tuab-683166cf6e154c6f3183ddd3f10d0abf\">\n#top .flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-23tuab-683166cf6e154c6f3183ddd3f10d0abf{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-23tuab-683166cf6e154c6f3183ddd3f10d0abf av_one_full  avia-builder-el-47  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kbtmaahr-ef6d5c5feaa31ae2efd1b01248110ccd '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><div class=\"OutlineElement Ltr SCXW96382698 BCX2\" style=\"direction: ltr;\"><span class=\"TextRun SCXW96382698 BCX2\" lang=\"PT-BR\" style=\"font-size: 12pt; line-height: 18px; font-family: Times New Roman, Times New Roman_EmbeddedFont, Times New Roman_MSFontService, serif; font-weight: normal;\" data-contrast=\"auto\"><span class=\"NormalTextRun SCXW96382698 BCX2\" style=\"background-color: inherit;\">Quanto a ptose adquirida ela pode ser dividida em ptose de origem neurog\u00eanica, por 1. altera\u00e7\u00e3o no nervo oculomotor ou no simp\u00e1tico ocular; 2. altera\u00e7\u00e3o na jun\u00e7\u00e3o neuromuscular, 3. Altera\u00e7\u00e3o\u00a0 miog\u00eanica e 4. Altera\u00e7\u00f5es locais da p\u00e1lpebra.<\/span><\/span><span class=\"EOP SCXW96382698 BCX2\" style=\"font-size: 12pt; line-height: 18px; font-family: Times New Roman, Times New Roman_EmbeddedFont, Times New Roman_MSFontService, serif;\" data-ccp-props=\"{\">\u00a0<\/span><\/div>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-4rousf-cf61b7c1be04b33fe86d63bc329f4266\">\n#top .flex_column.av-4rousf-cf61b7c1be04b33fe86d63bc329f4266{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-4rousf-cf61b7c1be04b33fe86d63bc329f4266{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-4rousf-cf61b7c1be04b33fe86d63bc329f4266{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-4rousf-cf61b7c1be04b33fe86d63bc329f4266 av_one_full  avia-builder-el-49  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kn5g62cz-74cc586b2778c7f8ae6c87b8bc0c65cc\">\n#top .av-special-heading.av-kn5g62cz-74cc586b2778c7f8ae6c87b8bc0c65cc{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-kn5g62cz-74cc586b2778c7f8ae6c87b8bc0c65cc .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-kn5g62cz-74cc586b2778c7f8ae6c87b8bc0c65cc .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-kn5g62cz-74cc586b2778c7f8ae6c87b8bc0c65cc av-special-heading-h4 blockquote modern-quote  avia-builder-el-50  avia-builder-el-no-sibling '><h4 class='av-special-heading-tag '  itemprop=\"headline\"  > PTOSE NEUROG\u00caNICA <\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2h5bhb-dfcdb40c96fe5c3016e22a9d9c118b18\">\n#top .flex_column.av-2h5bhb-dfcdb40c96fe5c3016e22a9d9c118b18{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-2h5bhb-dfcdb40c96fe5c3016e22a9d9c118b18{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-2h5bhb-dfcdb40c96fe5c3016e22a9d9c118b18{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-2h5bhb-dfcdb40c96fe5c3016e22a9d9c118b18 av_three_fifth  avia-builder-el-51  el_after_av_one_full  el_before_av_two_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-kn5g5xr3-bf245ad5ffc95a93975604991b90f161 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Ptose de origem neurog\u00eanica na grande maioria dos casos ocorre por les\u00e3o do nervo oculomotor ou da via simp\u00e1tica ocular. No entanto, em raras ocasi\u00f5es pode tamb\u00e9m resultar de <strong>altera\u00e7\u00f5es supranucleares<\/strong>, quando se usa a denomina\u00e7\u00e3o ptose \u201ccerebral\u201d ou \u201ccortical\u201d.<br \/>\nPtose unilateral resultante de uma les\u00e3o em um hemisf\u00e9rio cerebral \u00e9 um achado bastante raro, ocorrendo do lado oposto da les\u00e3o e geralmente \u00e9 t\u00e3o discreto que pode n\u00e3o ser diagnosticada, especialmente em pacientes sonolentos. Hoyt (1969) refere uma paciente com epilepsia temporal focal que sempre come\u00e7ava do lado da ptose e na qual altera\u00e7\u00f5es ao eletroencefalograma foram observadas do lado oposto da les\u00e3o. Nesta paciente fotografias antigas permitiram confirmar que a ptose era adquirida. Casos como este nos quais o diagn\u00f3stico de ptose supranuclear parece justificado s\u00e3o, no entanto, bastante incomuns. Da mesma forma, embora poss\u00edvel, a ocorr\u00eancia de ptose bilateral por les\u00f5es supranucleares \u00e9 tamb\u00e9m incomum. O substrato anat\u00f4mico para este tipo de ptose n\u00e3o \u00e9 bem definido. Esta ocorr\u00eancia j\u00e1 foi relatada com les\u00f5es unilaterais do lobo temporal ou temporo-occipital e em les\u00f5es bilaterais que ocorrem nos lobos frontais.<br \/>\nA les\u00e3o do n\u00facleo, do fasc\u00edculo ou do <strong>nervo oculomotor<\/strong>, por outro lado representa uma causa muito mais comum de ptose neurog\u00eanica. O subn\u00facleo que inerva os m\u00fasculos elevadores \u00e9 uma estrutura \u00fanica na linha m\u00e9dia que se localiza na por\u00e7\u00e3o caudal do <strong>n\u00facleo do oculomotor<\/strong> no mesenc\u00e9falo. As les\u00f5es que acometem esta regi\u00e3o produzem ptose, que \u00e9 bilateral e associada a outras disfun\u00e7\u00f5es oculomotoras como exotropia, limita\u00e7\u00e3o da eleva\u00e7\u00e3o, adu\u00e7\u00e3o, eleva\u00e7\u00e3o ou depress\u00e3o do olho, de acordo com o acometimento de outros subn\u00facleos do oculomotor. Nestes casos geralmente tamb\u00e9m ocorrem outros sinais mesencef\u00e1licos tais como paralisia do olhar conjugado vertical, les\u00e3o do nervo troclear e desvio skew, embora em alguns casos a ptose bilateral possa ser o achado predominante. As les\u00f5es mesencef\u00e1licas que podem causar ptose por acometimento do n\u00facleo do elevador s\u00e3o in\u00fameras e incluem les\u00f5es isqu\u00eamicas, desmielinizantes, inflamat\u00f3rias, infiltrativas e compressivas. Raramente este tipo de ptose pode ser cong\u00eanita por aplasia ou displasia do n\u00facleo do oculomotor.<\/p>\n<p>A ptose por<strong> les\u00e3o do fasc\u00edculo<\/strong> ou do <strong>nervo oculomotor<\/strong> \u00e9 quase sempre unilateral. O diagn\u00f3stico \u00e9 estabelecido pela observa\u00e7\u00e3o do acometimento de outros m\u00fasculos extraoculares levando a limita\u00e7\u00e3o da adu\u00e7\u00e3o, eleva\u00e7\u00e3o e abaixamento do olho acometido. O acometimento pupilar \u00e9 bastante freq\u00fcente embora n\u00e3o seja obrigat\u00f3rio e esteja ausente em algumas condi\u00e7\u00f5es, em especial vasculopatias.<\/p>\n<\/div><\/section><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-23tuab-f46a577dd5b36841ab1bf705ea48708d\">\n#top .flex_column.av-23tuab-f46a577dd5b36841ab1bf705ea48708d{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-23tuab-f46a577dd5b36841ab1bf705ea48708d{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-23tuab-f46a577dd5b36841ab1bf705ea48708d{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-23tuab-f46a577dd5b36841ab1bf705ea48708d av_two_fifth  avia-builder-el-53  el_after_av_three_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-kcl1v6zj-7abfcb5902617db025657b13564e32c2\">\n.avia-image-container.av-kcl1v6zj-7abfcb5902617db025657b13564e32c2 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-kcl1v6zj-7abfcb5902617db025657b13564e32c2 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-kcl1v6zj-7abfcb5902617db025657b13564e32c2 av-styling- avia-align-center  avia-builder-el-54  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4014 avia-img-lazy-loading-not-4014 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-7.jpg\" alt='Ptose por paralisia oculomotora' title='Ptose por paralisia oculomotora'  height=\"763\" width=\"561\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-7.jpg 561w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-7-221x300.jpg 221w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-7-518x705.jpg 518w\" sizes=\"(max-width: 561px) 100vw, 561px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-kcl27l79-dfd0782439ad9b942a7f16b441a4f1e9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 7. Ptose por paralisia oculomotora. Observe o d\u00e9ficit de eleva\u00e7\u00e3o e a midr\u00edase a esquerda (foto do meio) e o d\u00e9ficit de adu\u00e7\u00e3o do olho esquerdo (foto abaixo).<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-xd9jhr-73a3fe7a062681a20533f95d1c52e02b\">\n#top .flex_column.av-xd9jhr-73a3fe7a062681a20533f95d1c52e02b{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-xd9jhr-73a3fe7a062681a20533f95d1c52e02b{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-xd9jhr-73a3fe7a062681a20533f95d1c52e02b{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-xd9jhr-73a3fe7a062681a20533f95d1c52e02b av_one_full  avia-builder-el-56  el_after_av_two_fifth  el_before_av_one_fifth  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-knawvhon-7b54fb8721d39ac765e1a9b31f5a930a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">\u00c9 importante observar que o acometimento de outros m\u00fasculos extraoculares e da pupila podem ser muito discretos e devem ser objeto de pesquisa cuidadosa.\u00a0 Deve ser avaliado o alinhamento ocular pela oclus\u00e3o alternada dos olhos com o paciente fixando um determinado objeto, e colocando o paciente nas diversas posi\u00e7\u00f5es do olhar, uma vez que em alguns casos a limita\u00e7\u00e3o da motilidade ocular pode ser bastante discreta.\u00a0 A medida do desvio ocular com o uso de lentes prism\u00e1ticas \u00e9 muitas vezes fundamental para se estabelecer o diagn\u00f3stico de uma paralisia oculomotora nos casos onde a limita\u00e7\u00e3o da movimenta\u00e7\u00e3o ocular \u00e9 discreta. \u00c9 importante tamb\u00e9m a observa\u00e7\u00e3o da ptose palpebral no que se refere \u00e0 pesquisa de sinais de regenera\u00e7\u00e3o aberrante do nervo oculomotor, que se manifesta especialmente no olhar para baixo e para dentro quando se observa eleva\u00e7\u00e3o (anormal) da p\u00e1lpebra. A regenera\u00e7\u00e3o aberrante do oculomotor pode ocorrer ap\u00f3s a recupera\u00e7\u00e3o de paralisias causadas em especial por les\u00f5es traum\u00e1ticas e \u00e9 um sinal diagn\u00f3stico importante em muitos casos. Mais importante ainda \u00e9 a observa\u00e7\u00e3o de regenera\u00e7\u00e3o aberrante prim\u00e1ria onde os sinais de regenera\u00e7\u00e3o an\u00f4mala ocorrem junto com o desenvolvimento da ptose e da paralisia oculomotora. Trata-se de um sinal bastante sugestivo de uma les\u00e3o compressiva de longa dura\u00e7\u00e3o ao n\u00edvel do seio cavernoso, em especial os <\/span><span data-contrast=\"auto\">meningiomas<\/span><span data-contrast=\"auto\"> do seio cavernoso.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Ptose \u00e9 tamb\u00e9m um sinal importante nas les\u00f5es da via simp\u00e1tica destinada aos olhos <\/span><b><span data-contrast=\"auto\">(s\u00edndrome de Horner).<\/span><\/b><span data-contrast=\"auto\"> Observa-se ptose parcial que geralmente \u00e9 discreta, vari\u00e1vel e associada \u00e0 miose ipsilateral. A miose pode passar despercebida se ambas as pupilas forem pequenas e se o paciente n\u00e3o for examinado com pouca ilumina\u00e7\u00e3o<\/span><span data-contrast=\"auto\"> (Figura 8).<\/span><span data-contrast=\"auto\"> Pode-se observar tamb\u00e9m eleva\u00e7\u00e3o discreta da p\u00e1lpebra inferior e o <\/span><span data-contrast=\"auto\">enoftalmo<\/span><span data-contrast=\"auto\"> \u00e9 apenas aparente. Anidrose na face ipsilateral nem sempre est\u00e1 presente e a n\u00e3o se observa diplopia, diferentemente de v\u00e1rias outras causas de pt<\/span><span data-contrast=\"auto\">ose<\/span>.<\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-311u8f-15faef6125e8e589d3a48480796b0304\">\n#top .flex_column.av-311u8f-15faef6125e8e589d3a48480796b0304{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-311u8f-15faef6125e8e589d3a48480796b0304{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-311u8f-15faef6125e8e589d3a48480796b0304{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-311u8f-15faef6125e8e589d3a48480796b0304 av_one_fifth  avia-builder-el-58  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-38yov3-cc884f59fc173e7d5536a95e4b41bf62\">\n#top .flex_column.av-38yov3-cc884f59fc173e7d5536a95e4b41bf62{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-38yov3-cc884f59fc173e7d5536a95e4b41bf62{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-38yov3-cc884f59fc173e7d5536a95e4b41bf62{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-38yov3-cc884f59fc173e7d5536a95e4b41bf62 av_three_fifth  avia-builder-el-59  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-v0pcfz-d2bffd3213c78f16f2f21d4da48acb71\">\n.avia-image-container.av-v0pcfz-d2bffd3213c78f16f2f21d4da48acb71 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-v0pcfz-d2bffd3213c78f16f2f21d4da48acb71 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-v0pcfz-d2bffd3213c78f16f2f21d4da48acb71 av-styling- avia-align-center  avia-builder-el-60  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4015 avia-img-lazy-loading-not-4015 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-8.jpg\" alt='' title='s\u00edndrome de Horner'  height=\"295\" width=\"640\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-8.jpg 640w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-8-300x138.jpg 300w\" sizes=\"(max-width: 640px) 100vw, 640px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-knaww0c9-a426636c467d372ef932c08ea3b57b97 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 8. Ptose e miose a esquerda por s\u00edndrome de Horner decorrente de les\u00e3o hipotal\u00e2mica acometendo o primeiro neur\u00f4nio da via simp\u00e1tica.\u00a0\u00a0\u00a0<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-stq71r-0e71a65fe62f5d6b9359093b122b0a3e\">\n#top .flex_column.av-stq71r-0e71a65fe62f5d6b9359093b122b0a3e{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-stq71r-0e71a65fe62f5d6b9359093b122b0a3e{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-stq71r-0e71a65fe62f5d6b9359093b122b0a3e{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-stq71r-0e71a65fe62f5d6b9359093b122b0a3e av_one_full  avia-builder-el-62  el_after_av_three_fifth  el_before_av_one_full  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-knawwu42-274264481695a072e4a349571a24849a '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">\u00a0Na s\u00edndrome de Horner a ptose geralmente n\u00e3o causa sintoma e \u00e9 observada por algum parente do paciente ou representa um achado durante o exame. \u00c9 importante estabelecer se a ptose \u00e9 parte de uma s\u00edndrome de Horner ou representa uma <\/span><span data-contrast=\"auto\">pseudoptose<\/span><span data-contrast=\"auto\"> associada a uma anisocoria fisiol\u00f3gica. Na s\u00edndrome de Horner a pupila n\u00e3o dilata ap\u00f3s a instila\u00e7\u00e3o de col\u00edrio de coca\u00edna a 5% e este teste pode auxiliar grandemente o diagn\u00f3stico. Estabelecido o diagn\u00f3stico de s\u00edndrome de Horner, podemos usar o <\/span><span data-contrast=\"auto\">col\u00edro<\/span><span data-contrast=\"auto\"> de <\/span><span data-contrast=\"auto\">hidroxianfetamina<\/span><span data-contrast=\"auto\"> a 1% que auxilia na diferencia\u00e7\u00e3o do n\u00edvel da les\u00e3o ao longo da via do simp\u00e1tico ocular. Se n\u00e3o houver dilata\u00e7\u00e3o pupilar \u00e0 <\/span><span data-contrast=\"auto\">hidroxianfetamina<\/span><span data-contrast=\"auto\">, a les\u00e3o ocorreu no \u00faltimo neur\u00f4nio da via enquanto que na les\u00e3o do primeiro ou segundo neur\u00f4nio a pupila mostra dilata\u00e7\u00e3o ap\u00f3s a instila\u00e7\u00e3o do col\u00edrio. Outro sinal que pode ser \u00fatil \u00e9 a <\/span><span data-contrast=\"auto\">heterocromia<\/span><span data-contrast=\"auto\"> da \u00edris, que no entanto, est\u00e1 presente geralmente apenas <\/span><span data-contrast=\"auto\">na s\u00edndrome de <\/span><span data-contrast=\"auto\">Horner<\/span><span data-contrast=\"auto\"> cong\u00eanita (Figura 1).<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-rm5ha7-9b3ba42134a74b0d2dbfd07729e54542\">\n#top .flex_column.av-rm5ha7-9b3ba42134a74b0d2dbfd07729e54542{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-rm5ha7-9b3ba42134a74b0d2dbfd07729e54542{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-rm5ha7-9b3ba42134a74b0d2dbfd07729e54542{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-rm5ha7-9b3ba42134a74b0d2dbfd07729e54542 av_one_full  avia-builder-el-64  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-knax1920-26cc7e91a96457dea42d51428e23168c\">\n#top .av-special-heading.av-knax1920-26cc7e91a96457dea42d51428e23168c{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-knax1920-26cc7e91a96457dea42d51428e23168c .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-knax1920-26cc7e91a96457dea42d51428e23168c .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-knax1920-26cc7e91a96457dea42d51428e23168c av-special-heading-h4 blockquote modern-quote  avia-builder-el-65  avia-builder-el-no-sibling '><h4 class='av-special-heading-tag '  itemprop=\"headline\"  >PTOSE POR ALTERA\u00c7\u00c3O NA JUN\u00c7\u00c3O NEUROMUSCULAR <\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-q6cjxr-c0259d33d1c426fd3d5bc814e25eb177\">\n#top .flex_column.av-q6cjxr-c0259d33d1c426fd3d5bc814e25eb177{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-q6cjxr-c0259d33d1c426fd3d5bc814e25eb177{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-q6cjxr-c0259d33d1c426fd3d5bc814e25eb177{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-q6cjxr-c0259d33d1c426fd3d5bc814e25eb177 av_one_full  avia-builder-el-66  el_after_av_one_full  el_before_av_one_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-knax2r2y-467a3532a61a465aea6ff40d9a256ae9 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Altera\u00e7\u00f5es na jun\u00e7\u00e3o neuromuscular <\/span><span data-contrast=\"auto\">freq\u00fcentemente<\/span><span data-contrast=\"auto\"> causam ptose e incluem a Miastenia Gravis, a s\u00edndrome de Eaton Lambert e o botulismo. A <\/span><b><span data-contrast=\"auto\">Miastenia Gravis<\/span><\/b><span data-contrast=\"auto\"> representa uma causa importante de ptose, sendo este o sinal de apresenta\u00e7\u00e3o em torno de 25% dos casos. Geralmente a ptose ocorre de forma s\u00fabita em um olho mas logo se torna bilateral, embora geralmente predomine em um dos lados. Com muita <\/span><span data-contrast=\"auto\">freq\u00fc\u00eancia<\/span><span data-contrast=\"auto\"> a ptose <\/span><span data-contrast=\"auto\">alterna de um olho para o outro, sendo este um sinal <\/span><span data-contrast=\"auto\">patognom\u00f4nico<\/span><span data-contrast=\"auto\"> da miastenia. Os pacientes referem tamb\u00e9m que a ptose geralmente se acentua no final da tarde e varia bastante em intensidade durante o dia.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">O diagn\u00f3stico da ptose decorrente de Miastenia Gravis depende em parte da observa\u00e7\u00e3o de que n\u00e3o existem outros sinais indicativos de les\u00e3o no nervo oculomotor ou do simp\u00e1tico ocular. \u00c9 particularmente importante observar a aus\u00eancia de acometimento pupilar. Quanto \u00e0 movimenta\u00e7\u00e3o ocular esta pode tamb\u00e9m estar presente juntamente com a ptose, mas \u00e9 importante observar que n\u00e3o existe uma paresia com caracter\u00edsticas indicativas de acometimento do nervo oculomotor. No diagn\u00f3stico \u00e9 extremamente importante a anamnese observando a tend\u00eancia a acometimento bilateral, altern\u00e2ncia de acometimento de cada olho e variabilidade grande da ptose durante o dia ou de um dia para outro. Um teste muito importante no exame de tais paciente \u00e9 a observa<\/span><span data-contrast=\"auto\">\u00e7\u00e3o da <\/span><span data-contrast=\"auto\">fadigabilidade<\/span><span data-contrast=\"auto\"> palpebral.<\/span><span data-contrast=\"auto\"> Observa-se que a ptose aparece ou se acentua quando solicitamos ao paciente para olhar para cima por aproximadamente 2 minutos<\/span><span data-contrast=\"auto\"> (Figura 9)<\/span><span data-contrast=\"auto\">. Outro sinal importante \u00e9 a observa\u00e7\u00e3o do \u201c<\/span><span data-contrast=\"auto\">lid<\/span> <span data-contrast=\"auto\">twitch<\/span><span data-contrast=\"auto\">\u201d, descrito por <\/span><span data-contrast=\"auto\">Cogan<\/span><span data-contrast=\"auto\">. Quando pedimos ao paciente para olhar de baixo para cima, a p\u00e1lpebra muitas vezes executa um movimento exagerado, al\u00e9m do necess\u00e1rio para o movimento ocular correspondente, para em seguida cair um pouco, o que levou aquele autor a usar o nome acima mencionado. O diagn\u00f3stico pode tamb\u00e9m ser auxiliado pelo teste do cloreto de <\/span><span data-contrast=\"auto\">edrof\u00f4nio<\/span><span data-contrast=\"auto\"> (<\/span><span data-contrast=\"auto\">Tensilon<\/span><span data-contrast=\"auto\">), por via endovenosa, que geralmente mostra melhora importante da ptose logo ap\u00f3s a inje\u00e7\u00e3o sendo positivo em torno de 80 a 95% dos casos. O diagn\u00f3stico pode ainda ser auxiliado pelo uso da <\/span><span data-contrast=\"auto\">piridostigmina<\/span><span data-contrast=\"auto\"> ou <\/span><span data-contrast=\"auto\">neostigmina<\/span><span data-contrast=\"auto\"> por via intramuscular ou atrav\u00e9s da eletromiografia que mostra sinais caracter\u00edsticos da miastenia.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3hrowf-def87025b970697d48a5aa82d5275618\">\n#top .flex_column.av-3hrowf-def87025b970697d48a5aa82d5275618{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-3hrowf-def87025b970697d48a5aa82d5275618{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-3hrowf-def87025b970697d48a5aa82d5275618{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-3hrowf-def87025b970697d48a5aa82d5275618 av_one_fifth  avia-builder-el-68  el_after_av_one_full  el_before_av_two_third  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-o1sf9b-7677c861ad027ef3f18e33729ec9de53\">\n#top .flex_column.av-o1sf9b-7677c861ad027ef3f18e33729ec9de53{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-o1sf9b-7677c861ad027ef3f18e33729ec9de53{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-o1sf9b-7677c861ad027ef3f18e33729ec9de53{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-o1sf9b-7677c861ad027ef3f18e33729ec9de53 av_two_third  avia-builder-el-69  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-mbhmin-9414ac01c8450e3de8d4911df0108aa5\">\n.avia-image-container.av-mbhmin-9414ac01c8450e3de8d4911df0108aa5 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-mbhmin-9414ac01c8450e3de8d4911df0108aa5 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-mbhmin-9414ac01c8450e3de8d4911df0108aa5 av-styling- avia-align-center  avia-builder-el-70  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4016 avia-img-lazy-loading-not-4016 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-9.jpg\" alt='Ptose na miastenia gravis' title='Ptose na miastenia gravis'  height=\"197\" width=\"711\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-9.jpg 711w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-9-300x83.jpg 300w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-9-705x195.jpg 705w\" sizes=\"(max-width: 711px) 100vw, 711px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-knax37o9-bcd3df7a615684d28263753207fe77db '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 9. Ptose na miastenia gravis. Observe a queda palpebral esquerda ap\u00f3s olhar para cima durante 2 minutos.\u00a0<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-k2x8xr-600fe78fc5a640b825e303f8b1884199\">\n#top .flex_column.av-k2x8xr-600fe78fc5a640b825e303f8b1884199{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-k2x8xr-600fe78fc5a640b825e303f8b1884199{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-k2x8xr-600fe78fc5a640b825e303f8b1884199{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-k2x8xr-600fe78fc5a640b825e303f8b1884199 av_one_full  avia-builder-el-72  el_after_av_two_third  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-knax5aa5-ec236e9c87f3bc008b5e242009826385 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-ccp-props=\"{\">\u00a0<\/span><span data-contrast=\"auto\">Na s\u00edndrome de Eaton Lambert a ptose geralmente \u00e9 discreta, bilateral e n\u00e3o representa uma queixa significativa do paciente. Quanto ao botulismo tamb\u00e9m pode causar ptose em torno de um ter\u00e7o dos casos. Nestas duas condi\u00e7\u00f5es existem outros sinais cl\u00ednicos que geralmente permitem com facilidade o diagn\u00f3stico da ptose.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-j2nirj-c18adaecb8aee39e63af79478f762cd0\">\n#top .flex_column.av-j2nirj-c18adaecb8aee39e63af79478f762cd0{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-j2nirj-c18adaecb8aee39e63af79478f762cd0{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-j2nirj-c18adaecb8aee39e63af79478f762cd0{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-j2nirj-c18adaecb8aee39e63af79478f762cd0 av_one_full  avia-builder-el-74  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-knax8kaj-c0cf7c17dc64188775cbcc9118d51c6c\">\n#top .av-special-heading.av-knax8kaj-c0cf7c17dc64188775cbcc9118d51c6c{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-knax8kaj-c0cf7c17dc64188775cbcc9118d51c6c .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-knax8kaj-c0cf7c17dc64188775cbcc9118d51c6c .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-knax8kaj-c0cf7c17dc64188775cbcc9118d51c6c av-special-heading-h4 blockquote modern-quote  avia-builder-el-75  avia-builder-el-no-sibling '><h4 class='av-special-heading-tag '  itemprop=\"headline\"  >PTOSE MIOG\u00caNICA<\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-h12rtr-c90fc85ae715a432a2322698dd19c324\">\n#top .flex_column.av-h12rtr-c90fc85ae715a432a2322698dd19c324{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-h12rtr-c90fc85ae715a432a2322698dd19c324{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-h12rtr-c90fc85ae715a432a2322698dd19c324{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-h12rtr-c90fc85ae715a432a2322698dd19c324 av_one_full  avia-builder-el-76  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-knax9chj-fa8cfa73c647b5602c1cb32912c459fa '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Ptose miog\u00eanica geralmente \u00e9 bilateral e se desenvolve insidiosamente ao longo de v\u00e1rios anos. Os pacientes tendem a se adaptar ao d\u00e9ficit e geralmente se queixam apenas em est\u00e1gios mais avan\u00e7ados da doen\u00e7a. O exame de fotografias antigas permite muitas vezes documentar a progress\u00e3o da afec\u00e7\u00e3o ao longo de v\u00e1rios anos. Em alguns pacientes a ptose \u00e9 isolada mas muitas vezes faz parte de um acometimento sist\u00eamico mais amplo.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Clinicamente observa-se ptose bilateral, que n\u00e3o apresenta os sinais de <\/span><span data-contrast=\"auto\">fadigabilidade<\/span><span data-contrast=\"auto\"> da miastenia, nem altera\u00e7\u00f5es musculares indicativas de paralisia oculomotora. A ptose pode ser isolada ou associada a <\/span><span data-contrast=\"auto\">oftalmoplegia<\/span><span data-contrast=\"auto\"> externa, com comprometimento da musculatura ocular extr\u00ednseca. N\u00e3o h\u00e1 envolvimento pupilar. A <\/span><b><span data-contrast=\"auto\">miopatia<\/span><\/b><b><span data-contrast=\"auto\"> ocular<\/span><\/b><span data-contrast=\"auto\"> ou <\/span><b><span data-contrast=\"auto\">oftalmoplegia<\/span><\/b><b><span data-contrast=\"auto\"> cr\u00f4nica externa<\/span><\/b> <b><span data-contrast=\"auto\">progressiva<\/span><\/b><span data-contrast=\"auto\"> consiste em uma variedade de altera\u00e7\u00f5es que tem uma evolu\u00e7\u00e3o lentamente progressiva, muitas vezes assim\u00e9trica, sendo a ptose o sinal inicial. Al\u00e9m da ptose observa-se envolvimento da musculatura extraocular com limita\u00e7\u00e3o da excurs\u00e3o dos olhos em todas as dire\u00e7\u00f5es. Em decorr\u00eancia do acometimento bilateral geralmente os pacientes n\u00e3o se queixam de <\/span><span data-contrast=\"auto\">diplopia. Algumas vezes ocorre o acometimento ocular se associa a acometimento sist\u00eamico como bloqueio de ramo card\u00edaco e a <\/span><span data-contrast=\"auto\">retinose<\/span><span data-contrast=\"auto\"> pigment\u00e1ria como na s\u00edndrome de <\/span><span data-contrast=\"auto\">Kearns-Sayre<\/span><span data-contrast=\"auto\">. O diagn\u00f3stico da miopatia muitas vezes requer bi\u00f3psia muscular, de prefer\u00eancia analisada \u00e0 microscopia eletr\u00f4nica. A idade de apresenta\u00e7\u00e3o e a progress\u00e3o pode variar bastante: a forma ocular pura com ptose e limita\u00e7\u00e3o da eleva\u00e7\u00e3o dos olhos geralmente se inicia mais precocemente do que aquela quando existe extens\u00e3o para os m\u00fasculos proximais dos membros. Uma heran\u00e7a autoss\u00f4mica dominante ocorre em 15 a 30% dos casos.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Nos casos espor\u00e1dicos o diagn\u00f3stico diferencial com miastenia pode ser dif\u00edcil num primeiro momento. No entanto, a aus\u00eancia dos sinais t\u00edpicos da miastenia e de resposta aos anticolin\u00e9rgicos permite a diferencia\u00e7\u00e3o.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">A <\/span><b><span data-contrast=\"auto\">miopatia<\/span><\/b> <b><span data-contrast=\"auto\">oculofar\u00edngea<\/span><\/b><span data-contrast=\"auto\"> \u00e9 uma doen\u00e7a de heran\u00e7a dominante, geralmente come\u00e7ando em torno de 50 anos de idade com ptose bilateral progressiva sem <\/span><span data-contrast=\"auto\">oftalmoplegia<\/span><span data-contrast=\"auto\"> e acompanhada mais tarde de disfagia. Tanto a ptose como a disfagia podem se tornar bastante severas. Outra condi\u00e7\u00e3o que pode causar ptose miog\u00eanica \u00e9 a <\/span><b><span data-contrast=\"auto\">distrofia <\/span><\/b><b><span data-contrast=\"auto\">miot\u00f4nica<\/span><\/b><span data-contrast=\"auto\"> onde a ptose bilateral e sim\u00e9trica \u00e9 comum, embora possa ser ausente em casos que tenham in\u00edcio tardio. O fechamento ocular tamb\u00e9m \u00e9 comprometido e a diplopia \u00e9 incomum, embora restri\u00e7\u00e3o sim\u00e9trica da movimenta\u00e7\u00e3o ocular possa estar presente.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-fvpsfj-938f345699869d36568555c6202cf7fb\">\n#top .flex_column.av-fvpsfj-938f345699869d36568555c6202cf7fb{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-fvpsfj-938f345699869d36568555c6202cf7fb{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-fvpsfj-938f345699869d36568555c6202cf7fb{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-fvpsfj-938f345699869d36568555c6202cf7fb av_one_full  avia-builder-el-78  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-knax9u1m-6ded1c21b10025055b44aa80e1f7ef93\">\n#top .av-special-heading.av-knax9u1m-6ded1c21b10025055b44aa80e1f7ef93{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-knax9u1m-6ded1c21b10025055b44aa80e1f7ef93 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-knax9u1m-6ded1c21b10025055b44aa80e1f7ef93 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-knax9u1m-6ded1c21b10025055b44aa80e1f7ef93 av-special-heading-h4 blockquote modern-quote  avia-builder-el-79  avia-builder-el-no-sibling '><h4 class='av-special-heading-tag '  itemprop=\"headline\"  >PTOSE POR ALTERA\u00c7\u00d5ES P\u00c1LPEBRAIS LOCAIS <\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-cm3lvj-f864ad87e0990f88a0ea9ba0e6985a43\">\n#top .flex_column.av-cm3lvj-f864ad87e0990f88a0ea9ba0e6985a43{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-cm3lvj-f864ad87e0990f88a0ea9ba0e6985a43{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-cm3lvj-f864ad87e0990f88a0ea9ba0e6985a43{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-cm3lvj-f864ad87e0990f88a0ea9ba0e6985a43 av_one_full  avia-builder-el-80  el_after_av_one_full  el_before_av_one_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-bfv47z-7dbb1bcf64f0625ec6034af7219c9e43 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">A ptose pode tamb\u00e9m ocorrer por altera\u00e7\u00f5es em especial senis, que ocorrem ao n\u00edvel da p\u00e1lpebra. Uma das formas mais comuns \u00e9 a que ocorre na <\/span><b><span data-contrast=\"auto\">ptose senil<\/span><\/b><span data-contrast=\"auto\"> ou <\/span><b><span data-contrast=\"auto\">ptose <\/span><\/b><b><span data-contrast=\"auto\">aponeur\u00f3tica<\/span><\/b><span data-contrast=\"auto\">, onde ocorre deisc\u00eancia da inser\u00e7\u00e3o do m\u00fasculo elevador da p\u00e1lpebra no tarso superior. Ocorre predominantemente em indiv\u00edduos idosos e representa uma causa bastante <\/span><span data-contrast=\"auto\">frequente<\/span><span data-contrast=\"auto\"> de ptose.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-32k2e7-fab5dc880c8affe2dc1522252be64d01\">\n#top .flex_column.av-32k2e7-fab5dc880c8affe2dc1522252be64d01{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-32k2e7-fab5dc880c8affe2dc1522252be64d01{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-32k2e7-fab5dc880c8affe2dc1522252be64d01{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-32k2e7-fab5dc880c8affe2dc1522252be64d01 av_one_fifth  avia-builder-el-82  el_after_av_one_full  el_before_av_three_fifth  first flex_column_div av-zero-column-padding  column-top-margin'     ><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-8vpuxb-434f5f7eeacdfa21f4ed7e3473dbcd0c\">\n#top .flex_column.av-8vpuxb-434f5f7eeacdfa21f4ed7e3473dbcd0c{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-8vpuxb-434f5f7eeacdfa21f4ed7e3473dbcd0c{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-8vpuxb-434f5f7eeacdfa21f4ed7e3473dbcd0c{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-8vpuxb-434f5f7eeacdfa21f4ed7e3473dbcd0c av_three_fifth  avia-builder-el-83  el_after_av_one_fifth  el_before_av_one_full  flex_column_div av-zero-column-padding  column-top-margin'     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-7omi5r-5c9d9e4788ae6b18eee1d8495d601727\">\n.avia-image-container.av-7omi5r-5c9d9e4788ae6b18eee1d8495d601727 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-7omi5r-5c9d9e4788ae6b18eee1d8495d601727 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-7omi5r-5c9d9e4788ae6b18eee1d8495d601727 av-styling- avia-align-center  avia-builder-el-84  el_before_av_textblock  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" fetchpriority=\"high\" class='wp-image-4017 avia-img-lazy-loading-not-4017 avia_image ' src=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-10.jpg\" alt='desinser\u00e7\u00e3o do m\u00fasculo elevador da palpebral' title='desinser\u00e7\u00e3o do m\u00fasculo elevador da palpebral'  height=\"263\" width=\"561\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-10.jpg 561w, https:\/\/clinicamariomonteiro.com.br\/site\/wp-content\/uploads\/2021\/04\/Figura-10-300x141.jpg 300w\" sizes=\"(max-width: 561px) 100vw, 561px\" \/><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-knaxc9ji-4822fb666a40ab8575c561fed0a288a0 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: center;\"><strong>Figura 10. Ptose senil acentuada por desinser\u00e7\u00e3o do m\u00fasculo elevador da palpebral\u00a0<\/strong><\/p>\n<\/div><\/section><\/p><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-5gahi7-678dfdb4300fa706df4444908a8b85f0\">\n#top .flex_column.av-5gahi7-678dfdb4300fa706df4444908a8b85f0{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-5gahi7-678dfdb4300fa706df4444908a8b85f0{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-5gahi7-678dfdb4300fa706df4444908a8b85f0{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-5gahi7-678dfdb4300fa706df4444908a8b85f0 av_one_full  avia-builder-el-86  el_after_av_three_fifth  el_before_av_one_full  first flex_column_div av-zero-column-padding  '     ><section  class='av_textblock_section av-knaxdmgi-d221fd6defec377f98c8bfd6897b8966 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">Na maioria dos indiv\u00edduos a ptose \u00e9 discreta e n\u00e3o representa um problema. A ptose geralmente \u00e9 bilateral, embora possa ser assim\u00e9trica e se desenvolve gradualmente sem outras altera\u00e7\u00f5es e sem acometimento dos m\u00fasculos extraoculares ou da pupila. Ocasionalmente ocorre ou se agrava ap\u00f3s cirurgia de catarata e pode tamb\u00e9m ocorrer em indiv\u00edduos mais jovens, especialmente usu\u00e1rios antigos de lente de contato. As principais caracter\u00edsticas deste tipo de ptose \u00e9 a observa\u00e7\u00e3o de uma boa excurs\u00e3o do m\u00fasculo elevador da p\u00e1lpebra, um sulco palpebral elevado ou ausente e um afilamento da p\u00e1lpebra superior acima do tarso. Muitos indiv\u00edduos referem piora da ptose ao final do dia, o que confunde ocasionalmente com miastenia gravis.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">Outras causas locais de ptose palpebral s\u00e3o os traumatismos diretos na p\u00e1lpebra e os tumores palpebrais que ocasionam aumento do volume das mesmas e queda da p\u00e1lpebra. Tais condi\u00e7\u00f5es, no entanto, geralmente s\u00e3o bastante \u00f3bvias ao exame e n\u00e3o apresentam dificuldades ao diagn\u00f3stico.<\/span><\/p>\n<p><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-3omlsf-89d1d8fd119927662f91defcd0824a26\">\n#top .flex_column.av-3omlsf-89d1d8fd119927662f91defcd0824a26{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-3omlsf-89d1d8fd119927662f91defcd0824a26{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-3omlsf-89d1d8fd119927662f91defcd0824a26{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  id=\"horner\"  class='flex_column av-3omlsf-89d1d8fd119927662f91defcd0824a26 av_one_full  avia-builder-el-88  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-knaxe0k9-09c11888a9e0556e27dd58583ff58932\">\n#top .av-special-heading.av-knaxe0k9-09c11888a9e0556e27dd58583ff58932{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-knaxe0k9-09c11888a9e0556e27dd58583ff58932 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-knaxe0k9-09c11888a9e0556e27dd58583ff58932 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-knaxe0k9-09c11888a9e0556e27dd58583ff58932 av-special-heading-h4 blockquote modern-quote  avia-builder-el-89  avia-builder-el-no-sibling '><h4 class='av-special-heading-tag '  itemprop=\"headline\"  >REFER\u00caNCIAS BIBLIOGR\u00c1FICAS <\/h4><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-2inrcv-e5aa3b2474e08292805f120a3c47c147\">\n#top .flex_column.av-2inrcv-e5aa3b2474e08292805f120a3c47c147{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n.flex_column.av-2inrcv-e5aa3b2474e08292805f120a3c47c147{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n.responsive #top #wrap_all .flex_column.av-2inrcv-e5aa3b2474e08292805f120a3c47c147{\nmargin-top:15px;\nmargin-bottom:10px;\n}\n<\/style>\n<div  class='flex_column av-2inrcv-e5aa3b2474e08292805f120a3c47c147 av_one_full  avia-builder-el-90  el_after_av_one_full  el_before_av_one_full  first flex_column_div av-zero-column-padding  column-top-margin'     ><section  class='av_textblock_section av-knaxew2f-590f47bcc3779fd72054e3e659867943 '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p><span data-contrast=\"auto\">1. <\/span><span data-contrast=\"auto\">Cogan<\/span><span data-contrast=\"auto\"> DG. Myasthenia gravis: A <\/span><span data-contrast=\"auto\">review<\/span> <span data-contrast=\"auto\">of<\/span> <span data-contrast=\"auto\">the<\/span> <span data-contrast=\"auto\">disease<\/span> <span data-contrast=\"auto\">and<\/span><span data-contrast=\"auto\"> a <\/span><span data-contrast=\"auto\">description<\/span> <span data-contrast=\"auto\">of<\/span> <span data-contrast=\"auto\">lid<\/span> <span data-contrast=\"auto\">twitch<\/span><span data-contrast=\"auto\"> as a <\/span><span data-contrast=\"auto\">characteristic<\/span><span data-contrast=\"auto\"> sign. <\/span><span data-contrast=\"auto\">Arch<\/span> <span data-contrast=\"auto\">Ophthalmol<\/span><span data-contrast=\"auto\"> 1965; 74:217-221<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">2. <\/span><span data-contrast=\"auto\">Frueh<\/span><span data-contrast=\"auto\"> BR. The <\/span><span data-contrast=\"auto\">mecanistic<\/span> <span data-contrast=\"auto\">classification<\/span> <span data-contrast=\"auto\">of<\/span> <span data-contrast=\"auto\">ptosis<\/span><span data-contrast=\"auto\">. <\/span><span data-contrast=\"auto\">Ophthalmology<\/span><span data-contrast=\"auto\">, 1980; 87:1019-21.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">3. Miller NR. <\/span><span data-contrast=\"auto\">Walsh<\/span> <span data-contrast=\"auto\">and<\/span> <span data-contrast=\"auto\">Hoyt<\/span> <span data-contrast=\"auto\">Clinical<\/span> <span data-contrast=\"auto\">Neuro-<\/span><span data-contrast=\"auto\">ophthalmology<\/span><span data-contrast=\"auto\"> 4 ed., Williams &amp; Wilkins, Baltimore, <\/span><span data-contrast=\"auto\">vol<\/span><span data-contrast=\"auto\"> 2,\u00a0 1985, 936-944<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">4. Monteiro MLR. Regenera\u00e7\u00e3o aberrante prim\u00e1ria do nervo oculomotor. <\/span><span data-contrast=\"auto\">Rev<\/span> <span data-contrast=\"auto\">Bras<\/span> <span data-contrast=\"auto\">Oftalmol<\/span><span data-contrast=\"auto\"> 1985; 44:14-17.\u00a0<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">5. <\/span><span data-contrast=\"auto\">Oosterhuis<\/span><span data-contrast=\"auto\"> HJGH. <\/span><span data-contrast=\"auto\">Acquired<\/span> <span data-contrast=\"auto\">blepharoptosis<\/span><span data-contrast=\"auto\">. <\/span><span data-contrast=\"auto\">Clin<\/span> <span data-contrast=\"auto\">Neurol<\/span> <span data-contrast=\"auto\">Neurosurg<\/span><span data-contrast=\"auto\"> 1996; 98:1-7.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">6. <\/span><span data-contrast=\"auto\">Walsh<\/span><span data-contrast=\"auto\"> FB, <\/span><span data-contrast=\"auto\">Hoyt<\/span><span data-contrast=\"auto\"> WF. <\/span><span data-contrast=\"auto\">Clinical<\/span> <span data-contrast=\"auto\">Neuro-<\/span><span data-contrast=\"auto\">Ophthalmology<\/span><span data-contrast=\"auto\">. 3rd ed., Williams &amp; Wilkins, Baltimore, Vol. 1, 1969, p. 298.<\/span><span data-ccp-props=\"{\">\u00a0<\/span><\/p>\n<\/div><\/section><\/div>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-33rs2r-c93d4393af5436c2a2cb836092cddd72\">\n.flex_column.av-33rs2r-c93d4393af5436c2a2cb836092cddd72{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-33rs2r-c93d4393af5436c2a2cb836092cddd72 av_one_full  avia-builder-el-92  el_after_av_one_full  avia-builder-el-last  first flex_column_div av-zero-column-padding  column-top-margin'     ><div  class='av-social-sharing-box av-kbv2qj7o-08b4e75ae03fda5eccfd0544f00b0dba av-social-sharing-box-default  avia-builder-el-93  avia-builder-el-no-sibling  av-social-sharing-box-fullwidth'><div class=\"av-share-box\"><h5 class='av-share-link-description av-no-toc '>Compartilhe<\/h5><ul class=\"av-share-box-list noLightbox\"><li class='av-share-link av-social-link-facebook avia_social_iconfont' ><a target=\"_blank\" aria-label=\"Share on Facebook\" href='https:\/\/www.facebook.com\/sharer.php?u=https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/&#038;t=Diagn%C3%B3stico%20Diferencial%20das%20Ptoses%20Palpebrais' data-av_icon='\ue8f3' data-av_iconfont='entypo-fontello'  title='' data-avia-related-tooltip='Share on Facebook'><span class='avia_hidden_link_text'>Share on Facebook<\/span><\/a><\/li><li class='av-share-link av-social-link-whatsapp avia_social_iconfont' ><a target=\"_blank\" aria-label=\"Share on WhatsApp\" href='https:\/\/api.whatsapp.com\/send?text=https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/' data-av_icon='\uf232' data-av_iconfont='entypo-fontello'  title='' data-avia-related-tooltip='Share on WhatsApp'><span class='avia_hidden_link_text'>Share on WhatsApp<\/span><\/a><\/li><li class='av-share-link av-social-link-linkedin avia_social_iconfont' ><a target=\"_blank\" aria-label=\"Share on LinkedIn\" href='https:\/\/linkedin.com\/shareArticle?mini=true&#038;title=Diagn%C3%B3stico%20Diferencial%20das%20Ptoses%20Palpebrais&#038;url=https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/' data-av_icon='\ue8fc' data-av_iconfont='entypo-fontello'  title='' data-avia-related-tooltip='Share on LinkedIn'><span class='avia_hidden_link_text'>Share on LinkedIn<\/span><\/a><\/li><li class='av-share-link av-social-link-mail avia_social_iconfont' ><a  aria-label=\"Share by Mail\" href='mailto:?subject=Diagn%C3%B3stico%20Diferencial%20das%20Ptoses%20Palpebrais&#038;body=https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/' data-av_icon='\ue805' data-av_iconfont='entypo-fontello'  title='' data-avia-related-tooltip='Share by Mail'><span class='avia_hidden_link_text'>Share by Mail<\/span><\/a><\/li><\/ul><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Ptose palpebral ou blefaroptose \u00e9 a condi\u00e7\u00e3o em que a margem da p\u00e1lpebra superior est\u00e1 situada em um n\u00edvel mais baixo que o normal, na posi\u00e7\u00e3o prim\u00e1ria do olhar, cobrindo mais do que 2 mm superiores da c\u00f3rnea. Pode ser causada por in\u00fameras condi\u00e7\u00f5es neurol\u00f3gicas e neuromusculares al\u00e9m de processos locais e anomalias cong\u00eanitas. <\/p>\n","protected":false},"author":3,"featured_media":4001,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[40],"tags":[42,44,43,41],"class_list":["post-3983","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ptoses-palpebrais","tag-nervo-oculomotor","tag-pseudoptose","tag-ptose-congenita","tag-ptoses-palpebrais"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Diagn\u00f3stico diferencial das Ptoses Palpebrais - Cl\u00ednica M\u00e1rio Monteiro<\/title>\n<meta name=\"description\" content=\"Ptose palpebral ou blefaroptose \u00e9 a condi\u00e7\u00e3o em que a margem da p\u00e1lpebra superior est\u00e1 situada em um n\u00edvel mais baixo que o normal.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/clinicamariomonteiro.com.br\/site\/diagnostico-diferencial-das-ptoses-palpebrais\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diagn\u00f3stico diferencial das Ptoses Palpebrais - 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