Congenital ptosis

Poor upper lid function,there is 
frontalis overaction

Poor upgaze due to superior
rectus weakness

Poor left skin crease

The left eye has poorly defined skin crease. There may be elevation of the chin to gain good binocular vision. 
The forehead may be wrinkled due to frontalis overaction. The upgaze is restricted (due to superior rectus 
muscle weakness and is the result of close embryologic development between it and the levator).The lid muscle may fail to relax on downgaze (not obvious in this patient; see figures below) and as result the ptotic eye is higher than the normal eye on down gaze.

Other examination:

  • look at the lid(s) for previous surgery and also the forehead for any scars from brow suspension slings
  • if the patient has glasses, check for anisometropia which is commonly seen in such patient.


1. What are the features of congenital ptosis?


2. How would you manage a patient with congenital ptosis?

Return to the main page
This 13 year-old boy underwent a  left anterior resection (note the scar) for 
congenital  ptosis. Note the failure of the left upper lid to relax on down-gaze. 
This is a commonfeature in patient with dystrophic levator and often become 
exaggerated  following anterior levator resection.