Ptosis is an abnormal condition of the eyes drooping the upper eyelids over
the eyes. Which may be either unilateral or bilateral and either may be partial or maybe complete.
Unilateral ptosis defines drooping one eyelid and bilateral
ptosis defines drooping both of the eyelids over the eyes.

When we open our eyes the upper eyelids cover 2mm to the
cornea. If upper eyelids cover the cornea 2mm and more than 2mm it is
called ptosis. The patients with ptosis little elevate their head for
seeing the things. Due to this problem, their eyelids become droopy and
wrinkles become on their forehead. Their palpebral aperture remains decreased
than the normal level. 


Palpebral aperture means space or gap between the upper and lower eyelids
of the eyes. Drooping the upper eyelids over the eyes is called “Palpebral Ptosis“.

Ptosis may be in adults and children.

What are the Causes of Ptosis and Types of Ptosis?

Types of Ptosis

There are two types of ptosis.
  1. Congenital Ptosis
  2. Acquired Ptosis
  3. Partial Ptosis
  4. Complete Ptosis

Congenital Ptosis

Congenital Ptosis is caused by maldevelopment of the
Levator muscles and weakness
of the superior rectus muscle.

Congenital ptosis is present at birth. It is a rare condition specified
the lower position of the upper eyelids above the eyes
. It may be unilateral or bilateral and if it is not treated it remains
permanent. Not all patients need surgery treatment only the patients having
amblyopia need surgery treatment.

In other cases, surgery can be delayed an ophthalmologist takes a decision
on the basis of parameters, grades of ptosis, functions of the
eyelids, and the risks of amblyopia.

There are several techniques to treat congenital ptosis. Sometimes
to correct congenital ptosis needs more than one technique.
Extraocular muscle development, neurologic dysfunction, and ptosis
surgery are some techniques for correcting upper eyelids.

Classification of Congenital Ptosis

  1. Simple Ptosis
  2. Complicated Ptosis

Simple Congenital Ptosis

It is usually unilateral and the skin eyelid crease is absent. The ptotic lid is higher in the downgaze position and
levator function is completely reduced.

Classification of Complicated Ptosis

  1. Motor Anomalies
  2. Marcus Gunn jaw winking Ptosis
  3. Blepharophimosis Syndrome

Motor Anomalies

It constitutes about 5% of all congenital ptosis. In this case, there is a
retraction of the ptotic eyelid with jaw movement. This is due to
misdirected cross innervation between the oculomotor nerve and mandibular
branch of the trigeminal nerve.

Blepharophimosis Syndrome

Blepharophimosis is a condition affecting the eyelids and ovary. Narrow
eyelids, droopy eyelids, an upward fold of skin of the inner lower eyelids
are four symptoms of this condition that a child can face after birth.

It comprises congenital ptosis, blepharophimosis,
telecanthus, epicanthus inversus.

Congenital Ptosis in Children

When Levator Palpebrae superioris muscle does not develop
properly and is weak in newborns. Then normally children can not open
one or both eyelids properly. 

It is obtained by often Hereditary Dominant. it is transferred
from parents into children.

It may be associated with Epicanthus or Blepharophimosis.
Epicanthus is a condition in which a fold of skin extends from the
eyelid over the inner canthus of the eyes

Acquired Ptosis

The Ptosis that is not present by birth is called “Acquired Ptosis“.
it normally occurs when the elevator muscles of the eyelids become

The function of this muscle is to keep open eyes. The wrong method of botox, excessive eye rubbing, long-term use of
contact lenses or eyelid pulling are also can cause acquired

Classification of Acquired Ptosis

It is classified into five categories.
  1. Neurogenic Ptosis
  2. Myogenic Ptosis ( Myasthenia Gravis)
  3. Aponeurotic ( Involutional) Ptosis
  4. Mechanical Ptosis
  5. Traumatic Ptosis

Neurogenic Ptosis

It is because of the
lesion of the nerves that
are supplying the upper eyelids. 
Neurogenic ptosis occurs when there is a problem in the nerve pathway
that controls the movement muscles of the eyelids

Myasthenia gravis, partial or complete third nerve palsy,
Ophthalmoplegic Migraine, Hornor syndrome, and multiple sclerosis are
the reasons for Neurogenic ptosis.

Myogenic Ptosis

It is due to the defect of the muscle or myoneural
Myogenic Ptosis occurs due to the Acquired disorders of the levator
palpebrae superioris muscle

Myasthenia gravis, Ocular Myopathy, and Bilateral Senile
Ptosis are the reasons for myogenic ptosis.

Aponeurotic Ptosis (Involutional Ptosis)

Involutional Ptosis due to the dehiscence, disinsertion, or
stretching of the
levator aponeurosis. It has a
feature the skin eyelid is at a higher level and levator function is

Mechanical Ptosis

It is due to the increased weight of the upper eyelid caused by the
lesion. The lesion can be a tumor or
When our eyelids have more weight due to these conditions then eyelids
will droop definitely.

Conjunctival Scarring and Symblepharone of the upper eyelid are the causes
of mechanical ptosis.

Traumatic Ptosis

Traumatic ptosis occurs due to the trauma of the Levator palpebrae
superioris muscle

When our eyelids suffer from an injury or trauma the
LPS muscles are present in the eyelids and our eyes become

it commonly occurs after Post Surgical and after
Cataract surgery.

Investigation of Ptosis

There are four techniques that are used to investigate the actual cause of
  1. Phenylephrine Test 
  2. Ice Test
  3. Neurological Investigation
  4. Tensilon Test

Grades of Ptosis

it is divided into three grades which are:
  1. Mild “1.2-2mm covers the upper part of the pupil” 
  2. Moderate ” 3mm covers the upper half of the pupil”
  3. Severe ” 4mm or more covers the whole pupillary area”

Treatment of Ptosis

There are two types of treatment
  1. Medical Treatment
  2. Surgical Treatment

Medical Treatment

It is indicated in myogenic and some cases of
neurogenic ptosis according to the underlying cause.

Surgical Treatment

It is done for
congenital ptosis and
all other types of ptosis. There are given below types of surgical
procedures that can be performed.
  1. Fasanella Servat Operation
  2. Levator Resection
  3. Brow Suspension Procedure
  4. Aponeurotic Strengthening
  5. Motais Operation
  6. Hess’s Operation
  7. Spectacle Props
See an Eye specialist for proper treatment of ptosis and follow his

Ruman Amjad

Hello, I am Dr. Ruman Amjad, an Ophthalmologist specializing in the field of eye care, particularly focused on helping individuals with swollen eyelids. I am thrilled to welcome you to, a comprehensive resource dedicated to providing accurate and reliable information on eyelid inflammation.


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