A review of acquired blepharoptosis: prevalence, diagnosis, and current treatment options

Abstract

Blepharoptosis (ptosis) is among the most common disorders of the upper eyelid encountered in both optometric and ophthalmic practice. The unilateral or bilateral drooping of the upper eyelid that characterises ptosis can affect appearance and impair visual function, both of which can negatively impact quality of life. While there are several known forms of congenital ptosis, acquired ptosis (appearing later in life, due to a variety of causes) is the predominant form of the condition. This review summarises the prevalence, causes, identification, differential diagnosis, and treatment of acquired ptosis. Particular attention is paid to the differential diagnosis of acquired ptosis and emerging treatment options, including surgical and pharmacologic approaches.

Fig. 1. Anatomy of the upper eyelid.

Adapted from Freddo and Chaum, 2017 [14]. The striated levator palpebrae superioris is innervated by the oculomotor nerve (cranial nerve III) and inserts, through its aponeurosis, on the anterior surface of the superior tarsal plate. Except in the eyelids of Asian individuals, the aponeurosis extends fibres through the orbicularis oculi muscle to reach the skin of the upper eyelid. The smooth Müller’s muscle arises from the underside of the levator and inserts on the superior tarsal plate. It is innervated by sympathetic fibres from the superior cervical ganglion [, –16].