Eyelid Ptosis

CLINICAL DIAGNOSTIC MANUAL

Eyelid ptosis is a condition where the upper eyelid droops more than normal, partially covering the eye and affecting vision. This condition can be unilateral or bilateral and can range in severity from mild eyelid drooping to complete obstruction of the visual field.

Ptosis can be congenital or acquired, with multiple etiologies, including neurological disorders, muscle diseases, and structural conditions. Identifying the underlying cause is essential to provide appropriate treatment and improve visual function and the patient’s quality of life.

Condition	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Oculomotor nerve (III) lesion	Unilateral ptosis, dilated pupil, eye deviated downward and outward, diplopia	History of trauma, aneurysm, or neurological conditions	Brain MRI or CT showing oculomotor nerve lesion
Horner’s syndrome	Mild ptosis, miosis, anhidrosis on the same side of the face	History of neck trauma or tumour, associated autonomic symptoms	Apraclonidine test, MRI or CT of neck and brain
Myasthenia gravis	Fluctuating ptosis, muscle weakness, worsens with use, improves with rest	History of fluctuating muscle weakness, Tensilon test	Anti-AChR antibody test, EMG showing response decrement
Myotonic dystrophy	Bilateral ptosis, generalised muscle weakness, myotonia, cataracts, frontal balding	Family history of myotonic dystrophy, progressive weakness	Genetic testing confirming DMPK gene mutation
Congenital ptosis	Ptosis present from birth, usually unilateral, variable function of the levator muscle	History of ptosis since birth, no other systemic symptoms	Clinical examination, exclusion of other acquired causes