Palpebral Ptosis: Clinical Classification, Differential Diagnosis, and Surgical Guidelines

Abstract

Palpebral ptosis indicates the abnormal drooping of the upper lid, caused by partial or total reduction in levator muscle function. It may be caused by various pathologies, both congenital and acquired. Based on a review of the available literature and on our own clinical experience, a classification is proposed as well as a differential diagnosis between ptosis and pseudoptosis. Some basic surgical guidelines related to age of onset and etiopathogenesis are drawn. Ptosis is divided into neurogenic, myogenic, aponeurotic, and mechanical. The aim of surgery is two fold: functional, to correct the limit in the visual field; and also aesthetic. From January 2000 to January 2004, 42 patients were referred and treated at the Unit of Cranio-Maxillofacial Surgery-Centre for Orbital Pathology and Surgery, Hospital and University, Ferrara, Italy. Of these, 12 cases were congenital and 30 acquired (13 were monolateral and 29 bilateral, for a total of 71 cases). The most widely used surgical techniques were levator muscle recession and frontalis suspension. In congenital forms, these techniques were often associated with techniques to correct oculo-muscular imbalance (i.e., strabismus).Seventy-one upper eyelids were treated, 5 of which were mild, 35 moderate, and 31 severe. Regarding levator muscle function, 60 were fair and 11 poor.Surgical treatment followed the indications and timing with good morphologic and aesthetic results. Complications included two cases of hypocorrection, two asymmetries, and two cases of hypercorrection. Surgical treatment of palpebral ptosis is complex and requires precise diagnosis and indications for surgery related to clinical examination and pathogenesis. Even if these indications are strictly followed, in some cases, the outcomes are unpredictable.