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JMR Lamina, Hanif & Ahmad, 2007

INCIDENCE AND AETIOLOGICAL FACTORS OF PTOSIS IN A


NIGERIAN SPECIALIST HOSPITAL
*LAMINA S, **HANIF MS & ***AHMAD RY
*Department of Physiotherapy, Faculty of Medicine, Jimma University, Jimma, Ethiopia.
**Department of Physiotherapy, Murtala Mohammad Specialist Hospital, Kano.
***Department of Physiotherapy, Bayero University, Kano.

Abstract
Introduction: Epidemiological data on ptosis are generally lacking in the developing nations.
Objective: The aim of this study was to assess the five years incidence and aetiological factors of ptosis in a Nigerian
Specialist Hospital.
Method: The records of patients’ diagnosis as ptosis between 2001 and 2005 were scrutinized. Data such as age, sex,
cause, socioeconomic status, side of ptosis and management were obtained.
Result: A total number of 104 patients were recorded. High prevalence was found as follows: (1) gender: male (69%);
(2) side: right side (64%); (3) cause: trauma (RTA) (60%); (4) socioeconomic status: students (28.8%) followed by
civil servants (23.1%); (5) age group: 51-60 years (25%).

Key Words: Ptosis; Prevalence; Causes; Incidence.


Correspondence: Lamina S, Department of Physiotherapy, Faculty of Medicine, Jimma University, Jimma,
Ethiopia.
Ph: 009-251471123021; e-mail: siklam_86@yahoo.co.uk

Introduction particularly the use of electrical stimulator in the


Ptosis means drooping of the upper eyelid management of ptosis. Furthermore, the outcome of
and is usually due to paralysis of the levator this study will provide baseline data which could be
palpebrae superioris (supplied by the third cranial used in future studies.
nerve) or paralysis of the orbital smooth muscles Patients/Methods
(supplied by the sympathetic nerve). Paralysis of the This study was carried out in Murtala
levator palpebrae superioris causes complete ptosis, Mohammad Specialist Hospital (MMSH), Kano,
while that of sympathetic nerve causes partial ptosis1. North-West Nigeria. The hospital was established in
Ptosis due to third cranial nerve and 1927 and has been the solely core hospital serving
sympathetic nerve palsy is usually unilateral, unless a patients from both metropolitan and rural areas as
situation occurs whereby the nerves on both sides of well as some neighboring states (Bauchi, Jigawa,
the body are paralysed at the same time. Other causes Katsina and Kaduna) and some nearby foreign
might be due to injury, diabetes, tumour, Horner’s countries such as Niger and Cameroon. The hospital
syndrome, Ophthalmoplegia, inflammation or also serves as a referral centre for other established
aneurysms. Bilateral ptosis is often due to government hospitals and private health
myasthenia gravis, myoneural junction disease, such establishments within and outside the state.
as botulism, primary disease of the muscles with The records of patients diagnosed as ptosis
muscular dystrophy and congenital ptosis1-2. during the period of five years (2001-2005) were
Many people want to correct ptosis because obtained from the statistical unit of the medical
it damages their appearance, in most cases, the record of the hospital. Data collected from the
sagging upper eyelid results in a loss of the superior patients’ files include the following: age, sex,
(upper) field of vision. Generally, literature seems aetiology of ptosis, side of ptosis, socioeconomic
scanty on the prevalence of ptosis and there have status (occupation), treatment given and referral for
been no studies on the prevalence and aetiology of physiotherapy. Descriptive analysis was used to
ptosis in Nigeria. Therefore, the purpose of this study analyse the data.
was to remedy the deficiency in literature by Results
determining the prevalence and aetiology of ptosis in A total of 104 ptosis patients were recorded
a Nigerian Specialist Hospital. It is believed that the between year 2001 and 2005. 72 (69%) males and 32
outcome of this study will sensitize the clinicians, (31%) females; 66 (64%) had right ptosis, 34 (32%)
ophthalmologist and physical therapist to initiate had left ptosis, while the remaining 4 (4%) presented
studies on noninvasive physical management with bilateral ptosis. The major aetiological factor

Journal of Medicine and Rehabilitation; Maiden Edition, March/April 2007 17

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Lamina, Hanif & Ahmad, 2007
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was trauma sustained in road traffic accident (RTA) ptosis (N=104)


62 (60%) followed by Ophthalmoplegia 26 (24.6%) Table 4: Five years (2001-2005) distribution pattern
and 6 (5.8%) was as a result of diabetes mellitus
(Table 1). Year (Jan – Dec) No of cases (%)
2005 39 (37.5)
Table 1: Aetiological distribution of ptosis during
2004 25 (24.0)
the period 2001-2005 (N=104)
2003 19 (18.3)
Causes No of Cases 2002 13 (12.5)
Trauma (RTA) 62 (60%) 2001 8 (7.7)
Ophthalmoplegia 26 (24.6%) Total 104 (100)
Diabetes mellitus 6 (5.8%) of incidence of ptosis (N=104)
Congenital 5 (4.8%)
No specific/associated cause 5 (4.8%) Discussion
Total 104 (100%) The study revealed increased prevalence of
ptosis with age; this is in agreement with the finding
The result showed an increase with age of Sridhavan et al3. The increased prevalence of
(table 2), the age groups of the patients as recorded ptosis with age in the present study could be linked
were as follows: < 1 year (4.0%), 2-10 years (6%), with the study carried out by Charlotte and Stuart4
11-20 years (15.0%), 21-30 years (23.0%) and 51-60 which states that the susceptibility of chronic
years (27.0%). The incidence of ptosis as shown in diseases increase with age; this increase is a
table 3 was highest among students (28.8%) followed reflection of both physiological changes and
by civil servants (23.1%), while under care was the cumulative environmental and genetic risk factor
least (5.8%). The result showed a steady increase in exposure. Results of the present study also showed
the incidence of ptosis from 2001 (7.7%) to 2005 that males have higher incidence of ptosis. Trauma
(37.5%) (Table 4). The major treatment given to the (RTA) was recorded as the highest aetiological factor
patients was chemotherapy (100%) while about 90% in Nigeria. The work of Sridhavan et al3 revealed a
were referred for physiotherapy. None of the cases contrary report. They reported mechanical injury as
recorded were referred for surgery, also ophthalmic the main aetiological factor of ptosis in Manchester
crutches were not available neither were they (England). In the present study, the incidence of
prescribed. ptosis was highest among students followed by civil
servants; also, the highest incidence of ptosis was
Table 2: Age distribution of ptosis during the period recorded in the year 2005.
Age group (years) No of cases (%) The reasons for high incidence of ptosis in
<1 4 (4) males, students and civil servants, and in the year
1 – 10 6 (6) 2005 may be linked to the high incidence of
11 – 20 16 (15) traumatic ptosis in RTA which could be as a result of
21 – 30 24 (23)
annual increase in the number of commercial motor
cyclists popularly called “Achaba” or “Okada” in
31 – 40 16 (15)
Nigeria specifically Kano city transport system.
41 – 50 10 (10)
These categories of people (students, civil servants
51 – 60 28 (27) and males) are the most mobile and most patronage
Total 104 (100) of these commercial motor cyclists for transportation.
of 2001-2005 (N=104) The present study revealed high incidence of
unilateral ptosis (96%); this concur with the report of
Table 3: Socioeconomic status and incidence of Sridhavan et al3, they reported about 61% unilateral
ptosis in Manchester. The high incidence of right
Socioeconomic Status No of Cases (%) ptosis reported in the present study may be attributed
Student 30 (28.8) to the fact that most people are right handed and
Civil servant 24 (23.1) there is high possibility for the right handed persons
Trader 14 (13.5) to fall on the right side/head in RTA or any incidence
Farmer 12 (11.5) of fall.
Full house wife 10 (9.6) Doctors as found out in this study referred
Unemployed (Idle) 8 (7.7) most of the patients for physical therapy. Reasons for
Under care 6 (5.8) their referral have no literature backup because
Total 104 (100)
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JMR Lamina, Hanif & Ahmad, 2007

presently there is dearth of data on physical therapy


management of ptosis but one could link their 3. Sridhavan GV, Tallis RC, Leatherbarrow B,
referral to the fact that physical therapy management Forman WM. A community survey of ptosis of
of facial and Bell’s palsy has been well established5-6. the eyelid and pupil size of elderly people. Age
They found it logical to refer similar paralysis (ptosis) and Aging 1995; 24: 21-4.
for physical therapy. Also, after a long term drug 4. Charlotte ER, Stuart GP. Molecular genetics and
prescription all to no avail coupled with age related disease. Age and Aging 2001; 30:
unavailability of facilities for surgery and ptosis 449-54.
crutches within the country and the cost of 5. Ayanniyi O, Akinpelu AO. The use of ultrasound
management abroad may be too enormous for the in the management of Bell’s palsy: Case studies.
patient, they found it reasonable to leave the patient Journal of the Nigerian Society of Physiotherapy
to the mercy of physical therapy. 1992; 11 (2): 31-4.
6. Lamina S, Hanif S. Physiotherapy and self
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