Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Med Life with Dr. Horton
    • Podcasts
    • Videos
    • Alerts
    • RSS
    • Classified ads
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Activate online account
    • Look up login
    • Earn CPD Credits
    • Members Corner
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
    • Activate subscription
    • Look up login
    • Manage account
    • Manage IPs
    • View Reports
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JPN

User menu

  • Subscribe
  • My alerts
  • My Cart
  • Log in

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JPN
  • Subscribe
  • My alerts
  • My Cart
  • Log in
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Med Life with Dr. Horton
    • Podcasts
    • Videos
    • Alerts
    • RSS
    • Classified ads
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Activate online account
    • Look up login
    • Earn CPD Credits
    • Members Corner
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
    • Activate subscription
    • Look up login
    • Manage account
    • Manage IPs
    • View Reports
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Practice

Eyelid ptosis

Colin W. McInnes and Matthew Lee-Wing
CMAJ October 06, 2015 187 (14) 1074; DOI: https://doi.org/10.1503/cmaj.140579
Colin W. McInnes
Section of Plastic Surgery (McInnes); Department of Ophthalmology (Lee-Wing), University of Manitoba, Winnipeg, Man.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: cmcinnes23@gmail.com
Matthew Lee-Wing
Section of Plastic Surgery (McInnes); Department of Ophthalmology (Lee-Wing), University of Manitoba, Winnipeg, Man.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Eyelid ptosis can obscure vision and impair activities of daily living

Eyelid ptosis (descent of the eyelid margin) is common (Figure 1; video available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140579/-/DC1).1 The condition can obstruct vision and interfere with daily activities, such as driving and reading.1 Associated complaints include fatigue of the muscles in the forehead from continuous eyebrow elevation in an effort to raise the eyelids, neck soreness from tilting the head back to see, and appearing sad or tired.

Figure 1:
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1:

Eyelid ptosis in a 12-year-old boy.

Many conditions can cause ptosis

Ptosis is most commonly the result of age-related stretching and dehiscence of the levator aponeurosis (60%). Other causes may be neurogenic (e.g., third-nerve palsy, myasthenia gravis, Horner syndrome; 6%), traumatic (11%), congenital (10%), mechanical (e.g., eyelid tumours; 9%) or myogenic (4%).2 Pseudoptosis can be caused by dermatochalasis (excess eyelid skin that may hang over the margin). The underlying cause will affect the type and urgency of referral.

Physical examination is usually sufficient to determine the diagnosis

The examination includes assessing the patient’s visual acuity, extraocular movements and pupillary light reflex, marginal reflex distance (distance from the corneal light reflex to the upper eyelid margin, about 4–5 mm), upper eyelid crease (often absent in congenital and age-related ptosis, and in people of Asian descent), palpebral fissure distance (about 9 mm), and eyelid excursion (about 15 mm; may be 0 mm in congenital cases).3

Surgical treatment is highly effective

Ptosis is typically corrected by outpatient surgery performed under local anesthetic, in which the position of the eyelid is adjusted and scars are hidden. Postoperative satisfaction is high, and many patients experience substantial improvement in functional status and appearance.4

Some treatments are covered by public health insurance in Canada

Treatments for cases in which aging has resulted in a substantial defect in the visual field (e.g., moderate to severe ptosis or dermatochalasis) or is caused by non–aging-related conditions are typically covered. Eligibility criteria vary by province, but formal visual field testing by an optometrist is usually required.

CMAJ invites submissions to “Five things to know about …” Submit manuscripts online at http://mc.manuscriptcentral.com/cmaj

See the following video online: Physical examination of eyelid ptosis. www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140579/-/DC1

Footnotes

  • Competing interests: None declared.

  • This article has been peer reviewed.

  • The authors have obtained patient consent.

References

  1. ↵
    1. Zoumalan CI,
    2. Lisman RD
    . Evaluation and management of unilateral ptosis and avoiding contralateral ptosis. Aesthet Surg J 2010;30:320–8.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Lim JM,
    2. Hou JH,
    3. Singa RM,
    4. et al
    . Relative incidence of blepharoptosis subtypes in an oculoplastics practice at a tertiary care center. Orbit 2013; 32:231–4.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Jindal K,
    2. Sarcia M,
    3. Codner MA
    . Functional considerations in aesthetic eyelid surgery. Plast Reconstr Surg 2014;134:1154–70.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Frueh BR,
    2. Musch DC,
    3. McDonald HM
    . Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology 2004;111:2158–63.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 187 (14)
CMAJ
Vol. 187, Issue 14
6 Oct 2015
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Eyelid ptosis
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
Citation Tools
Eyelid ptosis
Colin W. McInnes, Matthew Lee-Wing
CMAJ Oct 2015, 187 (14) 1074; DOI: 10.1503/cmaj.140579

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Eyelid ptosis
Colin W. McInnes, Matthew Lee-Wing
CMAJ Oct 2015, 187 (14) 1074; DOI: 10.1503/cmaj.140579
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Eyelid ptosis can obscure vision and impair activities of daily living
    • Many conditions can cause ptosis
    • Physical examination is usually sufficient to determine the diagnosis
    • Surgical treatment is highly effective
    • Some treatments are covered by public health insurance in Canada
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Scopus
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Zollinger–Ellison syndrome
  • Benign splenic regrowth mistaken as recurrent renal cell carcinoma
  • Plastic bronchitis in a 3-year-old boy
Show more Practice

Similar Articles

Collections

  • Sections
    • Five Things to Know About
  • Topics
    • Ophthalmology

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Videos
  • Alerts
  • RSS

Information for

  • Advertisers
  • Authors
  • CMA Members
  • Copyright and Permissions
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact

Copyright 2019, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

Powered by HighWire