Acquired Ptosis

Abstract

Acquired ptosis is defined as drooping of an upper eyelid that was previously in a correct anatomical position. Acquired ptosis is classified into the following four categories: (1) aponeurotic, (2) myogenic, (3) mechanical, or (4) neurogenic. Aponeurotic ptosis is the most prevalent, often diagnosed in the elderly population, and presents with thinning, stretching, or dehiscence of the aponeurosis. Myogenic ptosis arises from either a localized or systemic muscular or neuromuscular disease. Mechanical ptosis occurs when the eyelid is physically low secondary to a mass or edema. Neurogenic ptosis results from the disruption of innervation to the upper eyelid retractors, such as in the setting of a third cranial nerve palsy or Horner's syndrome. Evaluation of upper eyelid ptosis includes obtaining a detailed focused history of onset and associated symptoms and physical examination. Proper management for ptosis occurs only after determining the etiology.