The Nonsurgical Treatment of Ptosis

  • Ippolit C. A. Matjucha


The surgical treatment of blepharoptosis is in most cases dependably effective and safe; by comparison, nonsurgical treatment generally provides less satisfactory results and can be difficult for the patient to tolerate. Therefore, relatively few patients will prefer medical treatment for symptomatic, chronic ptosis, except as a temporizing measure before a definitive procedure. The possible mechanisms for lifting the eyelid nonsurgically are external mechanical devices (skin-taping, adhesives, or spectacle-based lid crutches) to retract the upper lid, topical eye drops to stimulate Müller’s muscle, and injectable botulinum toxin to weaken orbicularis tone.


Botulinum Toxin Myotonic Dystrophy Contact Allergy Horner Syndrome Chronic Progressive External Ophthalmoplegia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Mullaney PB, Nabi NU, Thorner P, Buncic R. Ophthalmic involvement as a presenting feature of nonorbital childhood parameningeal embryonal rhabdomyosarcoma. Ophthalmology. 2001;108(1):179–82.CrossRefPubMedGoogle Scholar
  2. 2.
    Mohan S, Ahmed SI, Alao OA, Schliep TC. A case of AIDS associated cryptococcal meningitis with multiple cranial nerve neuropathies. Clin Neurol Neurosurg. 2006;108(6):610–3.CrossRefPubMedGoogle Scholar
  3. 3.
    Sood BR, Sharma B, Kumar S, Gupta D, Sharma A. Facial palsy as first presentation of acute myeloid leukemia. Am J Hematol. 2003;74(3):200–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Miller MT, Strömland K. The Möbius sequence: a relook. J AAPOS. 1999;3(4):199–208.CrossRefPubMedGoogle Scholar
  5. 5.
    Lapid O, Lapid-Gortzak R, Barr J, Rosenberg L. Eyelid crutches for ptosis: a forgotten solution. Plast Reconstr Surg. 2000;106(5):1213–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Morrison J. Ptosis spectacles. Med Techn Bull. 1951;2(2):41–3.PubMedGoogle Scholar
  7. 7.
    Lundie RNG. The Lundie Loop. Myasthenia Gravis Association.
  8. 8.
    Walsh G, Rafferty PR, Lapin J. A simple new method for the construction of a ptosis crutch. Ophthalmic Physiol Opt. 2006;26(4):404–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Jain V, Natarajan S, Shome D, Gadgil D. Spectacle-induced ocular trauma: an unusual mechanism. Cornea. 2007;26(1):109–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Suhonen R, Kanerva L. Allergic contact dermatitis caused by palladium on titanium spectacle frames. Contact Dermatitis. 2001;44(4):257–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Summer B, Fink U, Zeller R, Rueff F, Maier S, Roider G, et al. Patch test reactivity to a cobalt-chromium-molybdenum alloy and stainless steel in metal-allergic patients in correlation to the metal ion release. Contact Dermatitis. 2007;57(1):35–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Widman TJ, Oostman H, Storrs FJ. Allergic contact dermatitis from medical adhesive bandages in patients who report having a reaction to medical bandages. Dermatitis. 2008;19(1):32–7.PubMedGoogle Scholar
  13. 13.
    Marks Jr JG, Rainey MA. Cutaneous reactions to surgical preparations and dressings. Contact Dermatitis. 1984;10(1):1–5.CrossRefPubMedGoogle Scholar
  14. 14.
    Osaki TH, Osaki MH, Belfort Jr R, Osaki T, Sant’anna AE, Haraguchi DK. Management of progressive myopathic blepharoptosis with daily application of octyl-2-cyanoacrylate liquid bandage. Ophthal Plast Reconstr Surg. 2009;25:264–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Garibaldi DC, Hindman HB, Grant MP, Iliff NT, Merbs SL. Effect of 0.5% apraclonidine on ptosis in Horner syndrome. Ophthal Plast Reconstr Surg. 2006;22(1):53–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Abdel-Latif AA, Akhtar RA, Zhou CJ. Effects of surgical sympathetic denervation on G-protein levels, alpha and beta-adrenergic receptors, cAMP production and adenylate cyclase activity in the smooth muscles of rabbit iris. Curr Eye Res. 1995;14(5):405–11.CrossRefPubMedGoogle Scholar
  17. 17.
    Koc F, Kavuncu S, Kansu T, Acaroglu G, Firat E. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis. Br J Ophthalmol. 2005;89(11):1442–4.CrossRefPubMedGoogle Scholar
  18. 18.
    Morales J, Brown SM, Abdul-Rahim AS, Crosson CE. Ocular effects of apraclonidine in Horner syndrome. Arch Ophthalmol. 2000;118(7):951–4.PubMedGoogle Scholar
  19. 19.
    Munden PM, Kardon RH, Denison C, Carter K. Palpebral fissure responses to topical adrenergic drugs. Am J Ophthalmol. 1991;111(6):706–10.PubMedGoogle Scholar
  20. 20.
    Scheinfeld N. The use of apraclonidine eyedrops to treat ptosis after the administration of botulinum toxin to the upper face. Dermatol Online J. 2005;11(1):9. Accessed October 15, 2009.PubMedGoogle Scholar
  21. 21.
    Wilkerson M, Lewis RA, Shields MB. Follicular conjunctivitis associated with apraclonidine. Am J Ophthalmol. 1991;111(1):105–6.PubMedGoogle Scholar
  22. 22.
    Spooner JJ. Ophthalmic disorders. In: Arcangelo VP, Peterson AM, editors. Pharmacotherapeutics for advanced practice: a practical approach. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006. p. 179.Google Scholar
  23. 23.
    Hennekes R. Adrenaline sensitivity of senile ptosis. Klin Monatsbl Augenheilkd. 1982;181(6):496–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Kass MA, Mandell AI, Goldberg I, Paine JM, Becker B. Dipivefrin and epinephrine treatment of elevated intraocular pressure: a comparative study. Arch Ophthalmol. 1979;97(10):1865–6. Scholar
  25. 25.
    Glatt HJ, Fett DR, Putterman AM. Comparison of 2.5% and 10% phenylephrine in the elevation of upper eyelids with ptosis. Ophthalmic Surg. 1990;21(3):173–6.PubMedGoogle Scholar
  26. 26.
    Nunes TP, Matayoshi S. Phenylephrine 10% eye drop action in the eyelid position in healthy subjects. Arq Bras Oftalmol. 2008;71(5):639–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Mapstone R. Provocative tests in closed-angle glaucoma. Br J Ophthalmol. 1976;60(2):115–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Brans JW, Aramideh M, Schlingemann RO, Oen VM, Speelman JD, Ongerboer de Visser BW. Cornea protection in ptosis induced by botulinum injection. Ned Tijdschr Geneeskd. 1996;140(19):1031–3.PubMedGoogle Scholar
  29. 29.
    Fagien S. Temporary management of upper lid ptosis, lid malposition, and eyelid fissure asymmetry with botulinum toxin type A. Plast Reconstr Surg. 2004;114(7):1892–902.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Neuro-opthalmologist, Comprehensive Surgical Ophthalmologist, Private PracticeSudburyUSA

Personalised recommendations