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Ptosis, Congenital: Differential Diagnoses & Workup

Author: Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Contributor Information and Disclosures

Updated: Nov 6, 2007

Differential Diagnoses

Anophthalmos
Corneal Abrasion
Cellulitis, Orbital
Corneal Foreign Body
Cellulitis, Preseptal
Dermoid, Orbital
Chronic Progressive External Ophthalmoplegia
Duane Syndrome
Conjunctivitis, Allergic
Horner Syndrome
Conjunctivitis, Bacterial
Marcus Gunn Jaw-winking Syndrome
Conjunctivitis, Giant Papillary
Myasthenia Gravis
Conjunctivitis, Viral
Thyroid Ophthalmopathy

Other Problems to Be Considered

Acquired myogenic ptosis
Aponeurotic ptosis
Neurogenic ptosis
Mechanical ptosis
Traumatic ptosis
Pseudoptosis
Blepharochalasis
Myotonic dystrophy
Kearns-Sayre syndrome
Acquired blepharoptosis

Workup

Laboratory Studies

  • If myasthenia gravis is suspected, check serum acetylcholine receptor antibody levels.

Imaging Studies

  • The following are indications to perform neuroimaging studies (eg, MRI, CT) of the orbit and brain:
    • History not consistent and onset not clear
    • Other neurologic findings along with ptosis
    • Orbital wall fracture suspected with history of trauma
    • Visible or palpable lid mass
    • Orbital tumors (eg, lymphoma, leukemia, rhabdomyosarcoma) suspected
    • New onset of Horner syndrome with or without other neurologic findings
    • New onset third cranial nerve palsy with or without other neurologic findings
    • Globe displacement with either enophthalmos or proptosis

Other Tests

  • If myasthenia gravis is suspected, the following tests are recommended:
    • Single fiber electromyography (EMG)
    • Tensilon test
    • Ice test
  • If a mitochondrial disorder is suspected, an ECG is recommended.

Procedures

  • If a mitochondrial disorder is suspected, a muscle biopsy should be performed.

More on Ptosis, Congenital

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

  1. Bagheri A, Aletaha M, Saloor H, Yazdani S. A randomized clinical trial of two methods of fascia lata suspension in congenital ptosis. Ophthal Plast Reconstr Surg. May-Jun 2007;23(3):217-21. [Medline].

  2. Bergin DJ. Management and surgery of congenital and acquired ptosis. Continuing Ophthalmic Video Education. 1990.

  3. Bernardini FP, Devoto MH, Priolo E. Treatment of unilateral congenital ptosis. Ophthalmology. Mar 2007;114(3):622-3. [Medline].

  4. Clark BJ, Kemp EG, Behan WM, Lee WR. Abnormal extracellular material in the levator palpebrae superioris complex in congenital ptosis. Arch Ophthalmol. Nov 1995;113(11):1414-9. [Medline].

  5. Guercio JR, Martyn LJ. Congenital malformations of the eye and orbit. Otolaryngol Clin North Am. Feb 2007;40(1):113-40, vii. [Medline].

  6. Malone TJ, Nerad JA. The surgical treatment of blepharoptosis in oculomotor nerve palsy. Am J Ophthalmol. Jan 15 1988;105(1):57-64. [Medline].

  7. Meyer DR, Rheeman CH. Downgaze eyelid position in patients with blepharoptosis. Ophthalmology. Oct 1995;102(10):1517-23. [Medline].

  8. Wabbels B, Schroeder JA, Voll B, Siegmund H, Lorenz B. Electron microscopic findings in levator muscle biopsies of patients with isolated congenital or acquired ptosis. Graefes Arch Clin Exp Ophthalmol. Oct 2007;245(10):1533-41. [Medline].

  9. Weinberg DA, Lesser RL, Vollmer TL. Ocular myasthenia: a protean disorder. Surv Ophthalmol. Nov-Dec 1994;39(3):169-210. [Medline].

  10. Yilmaz N, Hosal BM, Zilelioglu G. Congenital ptosis and associated congenital malformations. J AAPOS. Jun 2004;8(3):293-5. [Medline].

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Further Reading

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Keywords

congenital ptosis, drooping of the upper eyelid, droopy eyelid, droopy lid, droopy eye, congenital myogenic ptosis, congenital aponeurotic ptosis, congenital neurogenic ptosis, localized myogenic dysgenesis, amblyopia, strabismus, blepharoptosis

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Contributor Information and Disclosures

Author

Donny W Suh, MD, FAAP, Clinical Assistant Professor, Pediatric Ophthalmology Service, University of Nebraska Medical Center; Pediatric Ophthalmologist, Adult Strabismus Specialist, Wolfe Eye Clinic, PC; Consulting Staff, Blank Children's Hospital, Mercy Medical Center of Des Moines, Iowa Methodist Hospital of Des Moines, and Marshalltown Medical Center
Donny W Suh, MD, FAAP is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Medical Association, and Iowa Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Michael J Bartiss, OD, MD, Medical Director, Ophthalmology, Family Eye Care of the Carolinas
Michael J Bartiss, OD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Academy of Pediatrics, American Association for Pediatric Ophthalmology and Strabismus, American College of Surgeons, and North Carolina 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

Mark T Duffy, MD, PhD, Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal, and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic
Mark T Duffy, 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, Sigma Xi, and Society for Neuroscience
Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting; Quest medical - lacrimal balloons Honoraria Speaking and teaching

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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