Ocular System


Abnormal drooping of upper eyelid.

Abnormal drooping of upper eyelid.


Congenital ptosis

Congenital weakness (maldevelopment) of levator palpebrae superioris (LPS)
  • Syndromic associations:
  1. Simple congenital ptosis
  2. Congenital ptosis with associated weakness of superior rectus muscle
  3. Blepharophimosis-ptosis-epicanthus inversus syndrome (BPES)
  4. Congenital synkinetic ptosis (Marcus Gunn jaw-winking ptosis)
    • Retraction of ptotic lid with jaw movements

Neurogenic ptosis:

  1. Horner’s syndrome (CIII palsy)
  2. Ophthalmoplegic migraine
  3. Multiple sclerosis (MS)

Acquired myogenic ptosis:

Disorders of LPS or myoneural junction

Aponeurotic ptosis:

  • Involutional (senile) ptosis
  • Postoperative ptosis
  • Ptosis associated blepharochalasis
  • Traumatic dehiscence

Mechanical ptosis:

  • Cicatricial ptosis


Margin-reflex distance

Distance between upper lid margin and corneal reflection on pen torch held by examiner on which the patient fixates

Palpebral fissure height:

Distance between upper and lower lid margins
  • Mild: ≤ 2 mm
  • Moderate: ≤ 3mm
  • Severe: ≥ 4mm

Levator function (upper lid excursion):

Measured by placing thumb firmly against patient’s brow (to negate action of frantalis muscle) with the eyes in downgaze and the patient then looks up as far as possible.
  • Normal: ≥ 15mm
  • Good: 12-14mm
  • Fair: 5-11mm
  • Poor: ≤4mm


Congenital ptosis:

  1. Fasanella-Sevat operation (tarso-conjunctivo-mullerectomy)
  2. Levator resection:
    1. Blaskowick’s operation
    2. Everbusch’s operation
  3. Frontalis sling operation (brow suspension)

Acquired ptosis:

  • Treat underlying cause
  • Conservative treatment
  • Surgical treatment

Leave a Reply