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Title: Ptosis

Author: Celestine Gregerson, MSIII University of Utah; Tom Dowdle, Matriculated Medical Student, University of Utah

Photographer: James Gilman, CRA, FOPS


Figure 1: Congenital ptosis with the notable absence of a lid crease

Figure 2: Asymmetric bilateral ptosis, more severe on the left. Obstruction of the pupil is present on both sides, resulting in significant bilateral visual field impairment

Figure 3: Dermatochalasis causing pseudoptosis, or drooping of the skin above the eyelids resulting in the appearance of ptosis.


Blepharoptosis or ptosis refers to the drooping of the upper eyelid with an associated decrease in the vertical palpebral fissure, or the distance between the upper eyelid and lower eyelid.1,2 Ptosis occurs due to an abnormality in the structures that elevate the upper eyelid. In severe cases, ptosis can obstruct the pupil and cause visual field impairment. Etiologies include both congenital and acquired causes. Acquired causes include aponeurotic, neurogenic (the potentially emergent causes), and mechanical.


Classification & Etiology:


Ptosis should not be confused with pseudoptosis, which is the perceived appearance of a dropping eyelid due to abnormalities of the globe or surrounding skin1. Pseudoptosis most commonly occurs as a result of dermatocholasis, the process in which the skin above the eyelid becomes less elastic and droops below the eyelashes7. Other causes of pseudoptosis include severe enophthalmos, ipsilateral hypotropia, brow ptosis, and contralateral lid retraction giving the impression of relative ptosis of the opposite lid.7



Obtaining a thorough history, including any associated events or symptoms concerning for thyroid pathology or neurological abnormalities, is a first and critical step of ptosis evaluation7. The exam includes measuring:



After the emergent causes of ptosis have been ruled out or addressed, candidacy for nonsurgical therapies in patients with myasthenia gravis or Horner syndrome can be considered. Eyelid crutches can be attached to eyeglasses for temporary relief in some patients. Surgery is the definitive corrective measure for patients with ptosis causing superior visual field loss.1,2,7 A variety of surgical approaches can be taken, including resection of the levator aponeurosis or eyelid suspension.2,7,8

 Faculty Review: Griffin Jardine, MD


  1. Patel K, Carballo S, Thompson L. Ptosis. Disease-a-Month (Clinical Issues in Ophthalmology – Part II). 2017; 63(3):74-79.
  2. Sudhaker P, Vu Q, Kosoko-Lasaki O, Palmer M. Upper eyelid ptosis revisited. American Journal of Clinical Medicine. 2009; 6 (3):5-14.
  3. Baldwin HC, Manners RM. Congenital Blepharoptosis: A Literature Review of the Histology of Levator Palpebrae Superioris Muscle. Ophthalmic Plastic and Reconstructive Surgery. 2002; 18 (4):301-307.
  4.  Kersten RC, de Conciliis C, Kulwin DR. Acquired Ptosis in the Young and Middle-aged Adult Population. Ophthalmology. 1995; 102 (6):924-928.
  5. Mehat MS, Sood V, Madge S. Blepharoptosis Following Anterior Segment Surgery: a New Theory for an Old Problem. Orbit. 2012; 31 (4):274-278.
  6. Fujiwara T, Matsuo K, Kondoh S, Yuzuriha S. Etiology and Pathogenesis of Aponeurotic Blepharoptosis. Annals of Plastic Surgery. 2001; 46 (10):29-35.
  7. Fausett, BV, Nerad JA. Upper Eyelid Ptosis and Retraction. Diseases and Disorders of the Orbit and Ocular Adnexa. 2017; Ch 28: 525-539.
  8. Frueh BR, Musch DC, McDonald HMB. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology. 2004; 111(12):2158-2163.

Identifier: Moran_CORE_26610