• Congenital vs acquired
  • History of change
  • Hx of birth trauma, eye surgery (strabismus)
  • Hx of anesthesia problems, bleeding tendencies


  • Normal palpebral fissure: 12-14 mm in adult
  • Upper lid rests at upper limbus in the young and 1.5-2mm below in the adult. Lower lid at lower limbus
  • Upper eyelid crease: insertion of levator into skin
  • Lid droop : distance from lid margin to upper limbus or pupil margin (2 mm -mild, 4- severe)
  • Measure palpebral aperture in primary and lower gaze.
  • Levator excursion: normal -12-17 mm
  • >/= 8 mm is good, 5-7 fair, <4 is poor
  • Ptosis can exist with good LPS function due to aponeurosis dehiscence
  • Check for jaw-winking synkinesis of Marcus-Gunn, myasthenia gravis

Types of Ptosis:

Congenital: 55-60%, dev dystrophy of LPS

Acquired: 40 % of total

1. Neurogenic: III N injury or Nerve to Muller’s muscle ( Horner’s)

2. Myogenic:

  • Elderly, but maybe younger- Grave’s, pregnancy, etc
  • Due to LPS aponeurosis disinsertion or degeneration
  • Insidious, good LPS function (12 mm or more)
  • High lid crease and fold, thin eyelid
  • Myasthenia, Chr progressive ophthalmoplegia, oculopharyngeal dystrophy, myotonic dystrophy,

3. Traumatic:

4. Mechanical: tumors, scars

5. Pseudoptosis: Hypotropia, poor eyelid support (enophthamlos, Phthisis), Dermatochalasis, Brow ptosis

*Patient Results May Vary
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