Clinical features of blepharoptosis

Background: We report the main characteristics of blepharoptosis. Materials and methods:All cases of blepharoptosis treated at the Reims Univ ersity Hospital from 1992 to 1997 were reviewed. Ptosis, levator function, palpebral aperture, and the position of the upper crease were recorded as w ell as results of the epinephrine test, acethylcholine esterase inhibitor a ntibodies and computed tomography findings. Results:There were 96 unilateral and 34 cases of bilateral blepharoptosis ( 164 cases). The cases of congenital blepharoptosis (36 cases) were usually unilateral with severe ptosis and poor levator function. In cases with Clau de Bernard Horner syndrome, the blepharoptosis was unilateral with minimal ptosis and a positive response to neosynephrine. In cases with oculomotor n erve palsy (31 cases) the ptosis was moderate to severe and levator functio n was poor. In those with myastenia, the prostigmine test was positive. Lev ator aponeurotic disinsertion was observed in 16 cases with severe ptosis, positive response to neosnephrine and a high upper crease. There were three cases of trauma-induced ptosis, 5 cases of myopathy and 26 cases of idiopa thic ptosis. Discussion : The clinical presentation of blepharoptosis is usually related to the etiology. Bilateral blepharoptosis is most often observed in congen ital forms, levator disinsertion or idiopathic cases. Male sex predominates in congenital ptosis and oculomotor palsy, and female sex in Claude Bernar d Horner syndrome. Moderate to severe ptosis is observed in congenital ptos is or oculomotor palsy. The upper crease is absent in many cases of congeni tal blepharoptosis and is high in case of levator disinsertion. The respons e to neosynephrine is positive in Claude Bernard Horner syndrome and aponeu rotic disinsertion. The response to prostigmine is positive in case of myas thenia. Conclusions: Clinical aspects of blepharotosis are related to etiology. The different features guide surgical or medical treatment of blepharoptosis.