eMedicine Specialties > Ophthalmology > Lid

Ptosis, Adult: Multimedia

Author: Adam J Cohen, MD, Assistant Professor, Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Consulting Surgeon, Myers Wyse Center for the Eye; Director, Center for Facial Rejuvenation
Coauthor(s): Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Contributor Information and Disclosures

Updated: Aug 29, 2008

Multimedia

Patient with bilateral ptosis before surgery. Not...
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Media file 1: Patient with bilateral ptosis before surgery. Note the high lid creases.
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Patient with bilateral ptosis before surgery. Not...

Patient with bilateral ptosis before surgery. Note the high lid creases.

Same patient as in Media file 1 after bilateral i...
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Media file 2: Same patient as in Media file 1 after bilateral internal levator advancement. No skin incision was made, and no crease reformation was performed.
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Same patient as in Media file 1 after bilateral i...

Same patient as in Media file 1 after bilateral internal levator advancement. No skin incision was made, and no crease reformation was performed.

Anterior approach to the levator. White band is ...
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Media file 3: Anterior approach to the levator. White band is the levator aponeurosis (arrow).
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Anterior approach to the levator. White band is ...

Anterior approach to the levator. White band is the levator aponeurosis (arrow).

Left ptosis. Lid crease is absent on the left. Th...
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Media file 4: Left ptosis. Lid crease is absent on the left. The crease is up in the sulcus. Superior sulcus deformity is present on the left and right, and the patient is elevating her brows. The right upper lid should be checked for an underlying or masked ptosis. If the right lid is ptotic, lifting the left lid causes the right lid to droop.
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Left ptosis. Lid crease is absent on the left. Th...

Left ptosis. Lid crease is absent on the left. The crease is up in the sulcus. Superior sulcus deformity is present on the left and right, and the patient is elevating her brows. The right upper lid should be checked for an underlying or masked ptosis. If the right lid is ptotic, lifting the left lid causes the right lid to droop.

Visual field shows functional blockage of superio...
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Media file 5: Visual field shows functional blockage of superior visual field due to a ptotic lid. Hashed line represents the superior extent of the seen visual field with the lid lifted. Solid line is with the lid in its natural, ptotic position.
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Visual field shows functional blockage of superio...

Visual field shows functional blockage of superior visual field due to a ptotic lid. Hashed line represents the superior extent of the seen visual field with the lid lifted. Solid line is with the lid in its natural, ptotic position.

Congenital ptosis on right. Note the presence of ...
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Media file 6: Congenital ptosis on right. Note the presence of a lid crease.
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Congenital ptosis on right. Note the presence of ...

Congenital ptosis on right. Note the presence of a lid crease.

Glasses with a crutch attached (arrow) that can b...
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Media file 7: Glasses with a crutch attached (arrow) that can be used to lift the lid if the patient does not desire surgery.
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Glasses with a crutch attached (arrow) that can b...

Glasses with a crutch attached (arrow) that can be used to lift the lid if the patient does not desire surgery.

Patient with myasthenia gravis. Right lid is mor...
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Media file 8: Patient with myasthenia gravis. Right lid is more ptotic than the left lid.
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Patient with myasthenia gravis. Right lid is mor...

Patient with myasthenia gravis. Right lid is more ptotic than the left lid.

Same patient as in Media file 8, 3 months later. ...
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Media file 9: Same patient as in Media file 8, 3 months later. Note how the ptosis has changed and is more on the left than the right.
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Same patient as in Media file 8, 3 months later. ...

Same patient as in Media file 8, 3 months later. Note how the ptosis has changed and is more on the left than the right.

Patient with bilateral ptosis before surgery.
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Media file 10: Patient with bilateral ptosis before surgery.
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Patient with bilateral ptosis before surgery.

Patient with bilateral ptosis before surgery.

Same patient as in Media file 10 after internal l...
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Media file 11: Same patient as in Media file 10 after internal levator advancement. Patient has excessive skin (dermatochalasia) after the lid was lifted, with a pseudoptotic effect more on the left than the right. The dermatochalasia was present before surgery but is more significant afterward. Patient also has brow ptosis.
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Same patient as in Media file 10 after internal l...

Same patient as in Media file 10 after internal levator advancement. Patient has excessive skin (dermatochalasia) after the lid was lifted, with a pseudoptotic effect more on the left than the right. The dermatochalasia was present before surgery but is more significant afterward. Patient also has brow ptosis.

More on Ptosis, Adult

Overview: Ptosis, Adult
Differential Diagnoses & Workup: Ptosis, Adult
Treatment & Medication: Ptosis, Adult
Follow-up: Ptosis, Adult
Multimedia: Ptosis, Adult
References
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References

  1. Arslan E, Demirkan F, Unal S, et al. Enhanced frontalis sling with double-fixed, solvent-dehydrated cadaveric fascia lata allograft in the management of eye ptosis. J Craniofac Surg. Nov 2004;15(6):960-4; discussion 965-6. [Medline].

  2. Beard C. Types of ptosis. In: Beard C, ed. Ptosis. 3rd ed. St. Louis: Mosby; 1981:39-76.

  3. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. Apr 1996;103(4):623-30. [Medline].

  4. Collin JRO. Ptosis. In: Manual of Systematic Eyelid Surgery. Oxford, England: Butterworth-Heinemann; 1999:41-72.

  5. Dinges WL, Witherspoon SR, Itani KM, Garg A, Peterson DM. Blepharoptosis and external ophthalmoplegia associated with long-term antiretroviral therapy. Clin Infect Dis. Sep 15 2008;47(6):845-52. [Medline].

  6. Dutton JJ. Atlas of Clinical and Surgical Orbital Anatomy. Philadelphia: WB Saunders; 1994:120-5.

  7. Emsen IM. A new ptosis correction technique: a modification of levator aponeurosis advancement. J Craniofac Surg. May 2008;19(3):669-74. [Medline].

  8. Frueh BR, Musch DC, McDonald H. Efficacy and efficiency of a new involutional ptosis correction procedure compared to a traditional aponeurotic approach. Trans Am Ophthalmol Soc. 2004;102:199-206; discussion 206-7. [Medline].

  9. Frueh BR, Musch DC, McDonald HM. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology. Dec 2004;111(12):2158-63. [Medline].

  10. Goldey SH, Baylis HI, Goldberg RA, et al. Frontalis muscle flap advancement for correction of blepharoptosis. Ophthal Plast Reconstr Surg. Mar 2000;16(2):83-93. [Medline].

  11. Levine MR. Manual of Oculoplastic Surgery. Oxford, England: Butterworth-Heinemann; 1996:75-105.

  12. Park DH, Baik BS. Advancement of the Müller muscle-levator aponeurosis composite flap for correction of blepharoptosis. Plast Reconstr Surg. Jul 2008;122(1):140-2. [Medline].

  13. Putterman AM. Cosmetic Oculoplastic Surgery Eyelid, Forehead, and Facial Techniques. London: WB Saunders; 1999:137-59.

  14. Sakol PJ, Mannor G, Massaro BM. Congenital and acquired blepharoptosis. Curr Opin Ophthalmol. Oct 1999;10(5):335-9. [Medline].

  15. Tsa CC, Li TM, La CS, et al. Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension. Br J Plast Surg. Sep 2000;53(6):473-6. [Medline].

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Further Reading

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Keywords

adult ptosis, blepharoptosis, droopy lid, droopy eyelid, drooping eyelid, upper eyelid ptosis, lazy eye, bedroom eyes

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Contributor Information and Disclosures

Author

Adam J Cohen, MD, Assistant Professor, Department of Ophthalmology, Northwestern University Feinberg School of Medicine; Consulting Surgeon, Myers Wyse Center for the Eye; Director, Center for Facial Rejuvenation
Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology and American College of Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Michael Mercandetti, MD, MBA, FACS, Consulting Staff, Department of Surgery, Doctors Hospital of Sarasota
Michael Mercandetti, MD, MBA, FACS is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American College of Surgeons, American Society for Laser Medicine and Surgery, American Society of Ophthalmic Plastic and Reconstructive Surgery, Association of Military Surgeons of the US, and Sarasota County Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Ron W Pelton, MD, PhD, Private Practice, Colorado Springs, Colorado
Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society, Utah Medical Association, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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