Involutional Ptosis

  • Jose Luis Tovilla


Aponeurotic ptosis, previously called senile or involutional ptosis, is the most common type of acquired ptosis. It is caused by a disinsertion or dehiscence of the levator aponeurosis from the tarsus. Clinical examination reveals a high lid crease, generally good levator function, and typically worsening of the ptosis on downgaze. These patients tend to do well with surgical correction, which involves advancement and reattachment of the levator aponeurosis to the anterior tarsal surface.


Levator Muscle Tarsal Plate Levator Aponeurosis Eyelid Position Eyelid Crease 
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  1. 1.
    Clauser L, Tieghi R, Galiè M. Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview. J Craniofac Surg. 2006;17(2):246–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Morax S. Involutional ptosis. J Fr Ophtalmol. 2006;29(6):703–11.CrossRefPubMedGoogle Scholar
  3. 3.
    Rathbun JE. Blepharoptosis. In: Rathbun JE, editor. Eyelid surgery. Boston, MA: Little, Brown and Company; 1983. p. 201–57.Google Scholar
  4. 4.
    Dortzbach RK, Sutula FC. Involutional blepharoptosis. A histopathological study. Arch Ophthalmol. 1980;98:2045–9.PubMedGoogle Scholar
  5. 5.
    Kersten RC, de Concilis C, Kulwin DR. Acquired ptosis in the young and middle-aged adult population. Ophthalmology. 1995;102:924–8.PubMedGoogle Scholar
  6. 6.
    Watanabe A, Araki B, Noso K, Kakizaki H, Kinoshita S. Histopathology of blepharoptosis induced by prolonged hard contact lens wear. Am J Ophthalmol. 2006;141:1092–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Shore JW, McCord Jr CD. Anatomic changes in involutional blepharoptosis. Am J Ophthalmol. 1984;98:2045–9.CrossRefGoogle Scholar
  8. 8.
    Jones LT, Quickert MH, Wobig JL. The cure of ptosis by aponeurotic repair. Arch Ophthalmol. 1975;93:629–34.PubMedGoogle Scholar
  9. 9.
    Sutula FC. Histological changes in congenital and acquired blepharoptosis. Eye. 1988;2:179–84.PubMedGoogle Scholar
  10. 10.
    Berke RN, Wadsworth JA. Histology of levator ­muscle in congenital and acquired ptosis. Arch Ophthalmol. 1955;53:413–28.Google Scholar
  11. 11.
    Collin JRO, Beard C, Wood I. Experimental and clinical data on the insertion of the levator palpebrae superioris muscle. Am J Ophthalmol. 1978;85:792–801.PubMedGoogle Scholar
  12. 12.
    Wojno TH. Downgaze ptosis. Ophthal Plast Reconstr Surg. 1993;9:83–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Holck DE, Dutton JJ, Wehrly SR. Changes in astigmatism after ptosis surgery measured by corneal topography. Ophthal Plast Reconstr Surg. 1998;14:151–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Jacobson D. The “ice pack test”. Ophthalmology. 1999;106:1282–6.CrossRefGoogle Scholar
  15. 15.
    Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External levator advancement vs Müller’s muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol. 2005;140(3):426–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Cahill K, Buerger G, Johnson B. Ptosis associated with fatty infiltration of Müller’s muscle and levator muscle. Ophthal Plast Reconstr Surg. 1986;2(4):213–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Frueh BR, Musch DC, McDonald HM. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology. 2004;111(12):2158–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Shovlin JP. The aponeurotic approach for the correction of blepharoptosis. Int Ophthalmol Clin. 1997;37(3):133–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Fasanella RM, Servat J. Levator resection for minimal ptosis: another simplified operation. Arch Ophthalmol. 1961;65:493.PubMedGoogle Scholar
  20. 20.
    Putterman AM, Urist MJ. Müller’s muscle-conjunctival resection. Arch Ophthalmol. 1975;93:619–23.PubMedGoogle Scholar
  21. 21.
    Dresner SC. Further modifications of Müller’s muscle conjunctival resection procedure for blepharoptosis. Ophthal Plast Reconstr Surg. 1991;7:114–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of OphthalmologyClínica Florida SateliteNaucalpánMexico

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