Blepharoptosis, or ptosis, refers to the drooping or downward displacement of the upper eyelid. The levator muscle, its aponeurosis, and the superior tarsal muscle are responsible for upper eyelid resting position and elevation. When these structures are compromised, the resultant depressed eyelid position can reduce the amount of light entering the eye, thereby degrading visual acuity. In pseudoptosis, aberrant structural relationships of the intact globe, bony, and soft-tissue attachments may cause secondary eyelid abnormalities.
Congenital myogenic, acquired aponeurotic, and involutional forms of ptosis represent the most common causes of ptosis among children and adults. Adults may be affected by associated involutional changes to the facial soft tissues that exacerbate or mask signs of ptosis. The vast majority of patients with ptosis do not present to an ophthalmologist or an oculoplastic surgeon for evaluation and treatment. Of those who do, their symptoms include headache, brow ache, and decreased visual acuity and visual field. Visual acuity improves with manual elevation of the eyelid and facial soft tissues. Superior visual field loss is most common. However, central vision can also be adversely affected. Any acute onset of ptosis, especially with other ocular or orbital symptoms, justifies further investigation with ophthalmological consultation.
- Involutional changes
- Prolapsed orbital fat
- Congenital myogenic ptosis
- Thyroid eye disease
- Previous eye-related surgery or implant
- Stye (hordeolum)
- Orbital cellulitis
- Orbital inflammatory syndrome
- Eyelid tumours
- Orbital tumours
- Chronic progressive external ophthalmoplegia (CPEO)
- Eyelid foreign body
- Eyelid laceration
Kiran Sajja, MD
Milan Eye Center
KS declares that he has no competing interests.
Allen M. Putterman, MD
Professor of Ophthalmology
Illinois Eye and Ear Infirmary
University of Illinois at Chicago
AMP declares that he has no competing interests.
Ilse Mombaerts, MD, PhD
Department of Ophthalmology
IM declares that she has no competing interests.
Alon Kahana, MD, PhD
Kellogg Eye Center
Ophthalmology and Visual Sciences
Comprehensive Cancer Center
University of Michigan
AK declares that he has no competing interests.
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