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Blepharoptosis

Background

Overview

Definition
Blepharoptosis, also known as ptosis, is defined as the downward displacement of the upper eyelid.
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Pathophysiology
Blepharoptosis is characterized by the dysfunction of the levator palpebrae superioris muscle or its innervation, leading to an insufficient or complete absence of levator muscle function.
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Epidemiology
The incidence of blepharoptosis in US is estimated at 7.9 per 100,000 children.
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Risk factors
Risk factors for blepharoptosis encompass age-related changes, congenital anomalies, trauma to the eyelid, and specific systemic diseases such as myasthenia gravis.
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Disease course
Clinically, blepharoptosis manifests primarily as a drooping of the upper eyelid. This can lead to visual field obstruction and eye fatigue, particularly in severe cases. In some instances, patients may also present with compensatory forehead wrinkles due to the increased effort to raise the eyelids.
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Prognosis and risk of recurrence
The prognosis of blepharoptosis can vary based on the underlying cause and the severity of the condition. Surgical interventions, such as levator resection or advancement, can effectively treat blepharoptosis and improve the visual field obstruction.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of blepharoptosis are prepared by our editorial team based on guidelines from the American Society of Plastic Surgeons (ASPS 2022). ...
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Diagnostic investigations

History and physical examination: as per ASPS 2022 guidelines, elicit a clinical history in patients presenting with low upper eyelid position, including the impact on the visual field or activities of daily living, and perform a physical examination to assess upper eyelid position (ptosis) relative to the pupil (such as margin-reflex distance 1) with photographic documentation and assessment of levator function.
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Surgical interventions

Blepharoplasty: as per ASPS 2022 guidelines, avoid performing blepharoplasty alone in patients with ptosis or low upper eyelid position.
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More topics in this section

  • Ptosis surgery

  • Browplasty

Follow-up and surveillance

Follow-up: as per ASPS 2022 guidelines, assess for complications, including asymmetry and lagophthalmos, within 1-3 months and again ideally at 9-12 months after upper eyelid ptosis correction and/or blepharoplasty.
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