BLEPHAROPTOSIS (the lowered eyelid)

Blepharoptosis or ptosis (eyelid ptosis) is not uncommon. We use this term when we say that the eyelid covers the cornea more than the normal one, i.e. when the opening between the eyelids is narrower. Normal upper eyelid covers the cornea for 1-2 mm.



Ptosis may be unilateral or bilateral, acquired or congenital. Ptoses, which do not exceed the area of the pupil, do not threaten the vision except when looking up, while the stronger ptosis prevents sight. Such people are trying to compensate the ptosis by raising the head. Congenital ptosis may completely cover the eye and this eye becomes visually impaired, in case it is not intervened in time to allow viewing. Most of unilateral ptoses act as a cosmetic defect.


Weakness of the pickup eyelid muscle (levator maldevelopment)

It was previously marked as a congenital (inborn) ptosis. It occurs due to the insufficient development of the muscle. The most important sign of this ptosis is the lag down of the eyelid when looking down. Sometimes, with this form of congenital ptosis are also associated strabismus, or upper right muscle weakness, and sometimes even refractive abnormalities, such as nearsightedness.

Muscular disease

This includes ptosis in chronic progressive external ophthalmoplegia, with myasthenia gravis, myotonic dystrophy, and congenital fibrosis of the extraocular muscles.

Aponeurotic ptosis

Occurs in later life, due to stretching of the aponeurosis levato (like rubber stretched on old pants), in its grip for the tarsus (the cartilage of the eyelid). It is associated with thinning of the eyelid and stretching of the eyelid skin.

Neurogenic ptosis

It arises from damage to the n. oculomotorius, trigeminal branch, which the lifter of the eyelid uses. Here is included the so-called Marcus Gunn phenomenon in which when you open your mouth comes to opening the ptosis’ eye, sometimes to the opening of the eye on the opposite side where the ptosis is. With the damage to the cervical sympathetic, ptosis occurs within Horner’s syndrome.

Mechanical ptosis

It occurs due to mechanical barriers to closing the eye or due to injuries and surgical treatments that have disrupted the normal relationships between certain structures. Thus, tumors and eyelid scars, surgery of the horizontal shortening of the lower eyelid, cataract surgery and eye enucleation (extraction of the eye) can result in left ptosis.


Treatment involves surgical treatment of ptoses in all cases listed, except for myasthenia gravis, where drugs are given. The goal of surgical treatment is to achieve symmetry of the eye.
If the function of the levater is preserved then it is possible to do the shortening of its aponeurosis, with the required procedure on the tarsus, conjunctiva and skin of the eyelid. If the function of the lid pickup is not preserved, then it goes on to the alternative routes such as connecting the lid with the musculus frontalis (subcutaneous muscle of the forehead). The operation must be well planned so not to have done insufficient or excessive correction.
It is particularly important to perform a lowered eyelid surgery in children on time, which hinders the development of vision and threatens to leave the eye visually impaired.