Ptosis

By: Rameen
Marginal
Reflex
Distance What is
ptosis?
- The dropping of
the eyelid
- Sometimes called
blepharoptosis
 The anatomy
- Eyelid retractors
a set of muscles that control how your eyes
open and close.
- The superior tarsal and levator
palpebrae superioris muscles both work
to open/close the upper eyelid.
- The lower eyelid uses inferior tarsal
muscles which are much smoother
So the lower eyelid has shape and motion
- The levator palpebrae superioris is a
skeletal muscle.
It raises the upper eyelid and to maintain the
upper eyelid position
- The superior tarsal muscle aka the Muller
What are the causes?
1. Congenital Some of the risk factors for ptosis
1. Rigid contact lenses
ptosis 2. Excessive eye rubbing
3. Eye surgery
2. Acquired. 4. Horner’s syndrome
The interruption of a neural route from
- Neurogenic the brain to the face and eye on one
side of the body causes a combination
- Myogenic of signs and symptoms.
Horner syndrome causes drooping
- Aponeurotic eyelids, decreased pupil size and
reduced sweating on the afflicted side
- Mechanical of the face.
Neurogenic Ptosis
*occurs when there is a problem with the nerve
pathway that controls movement of the eyelid
muscles.
Oculomotor nerve palsy: eye condition
resulting from damage to the third cranial
nerve that results in the inability to move
the eye normally
The oculomotor nerve divides into superior
and inferior divisions and these can be
damaged individually. The LPS is supplied
by the superior division. Superior divisional
palsies therefore cause ptosis and elevation
failure
 may occur due to a failure of
differentiation between the
levator palpebrae superioris
(LPS) from the superior rectus
muscle. So, it causes weakness in
the levator muscle

*eyelid trauma (scarring), and

MYOGENIC overuse/stretching of the eyelid
(long term contact lens use) may
PTOSIS
Myasthenia gravis
cause myogenic ptosis.

-in 85% of patients, one of

the initial symptom is ptosis
-ptosis can change on a the upper eyelid crease is often
minute-to-minute basis and absent or subtle.
classically the ptosis is
more severe in the evening
 Due to the Most common
defect in
the levator
aponeuroti
c linkage
Age related:occurs most often in the elderly
(between as an involutional disorder
the levator
muscle and Can occur post eyelid trauma/ post eyelid
the tarsal edema/ long-term post contact lens wear/
plate) but excessive eye rubbing/ eyelid pulling
in the
presence of
a normal
APONEUROTIC ptosis (Senile/involutional)
functioning
muscle
MECHANICAL
Due to excessive weight on the upper lid that causes
stretching of the thin eyelid skin
This may be due to:
- Eyelid tumor
- Orbital lesions (abnormal growths of tissue in the
structures that surround the eye)
- Cicatrizing conjunctival disorders (a group of
chronic local and systemic disorders that cause
conjunctival scarring)
 The effects of having ptosis
-have limited superior field vision—
which is the top part of your field of
vision
-can also have astigmatism where they
see blurry images
-may acquire additional visual
abnormalities, such as amblyopia, or
lazy eye, if they are not addressed.
When a child's eyesight is still growing
and one eye has entire vision and the
other has impaired vision due to ptosis,
the neural routes from the brain to the
Is there any cure?
1. Surgery: tighten the levator muscle or repair the
levator aponeurosis, which can help raise the eyelid.
*determining the optimal surgical approach, one must
consider the remaining levator function with the amount of
ptosis to be corrected
2. Ptosis crutch can be installed onto your existing
eyeglasses, easily and inexpensively.
 blepharoplasty
a type of surgery that
repairs droopy eyelids and
may involve removing
excess skin, muscle and fat.
Thank you