Ptosis in neurologic disease

Abstract

“Ptosis,” derived from the Greek word “fall,” is the abnormal lowering or prolapse of a structure; blepharoptosis refers to a lowering of the upper eyelid [1]. The normal position of the upper eyelid is dependent on the gender and ethnicity of each individual [2, 3]. The true frequency of ptosis and its particular subtypes is not known. A recent review of 484 cases of ptosis repair, excluding pseudoptosis, cited myogenic as the most common subgroup (42%), followed closely by aponeurotic (35.3%), and then “mixed” (15.9%). Neurogenic etiologies made up a minority of cases (6.8%) [4]. The surgical techniques and nuances of blepharoptosis correction are covered elsewhere in this text. The purpose of this chapter is to familiarize the clinician with the neurogenic causes of ptosis. Of the myriad categories, neurogenic ptosis is the most worrisome to the oculoplastic surgeon because of potential systemic morbidity and mortality. The clinician must be aware of this possibility, and follow a standard algorithm in the evaluation of all ptosis patients to assure that neurologic disease is not overlooked.