[Main semeiologic characteristics of ptosis]

We report the main characteristics of blepharoptosis.

All cases of blepharoptosis treated at the Reims University Hospital from 1992 to 1997 were reviewed. Ptosis, levator function, palpebral aperture, and the position of the upper crease were recorded as well as results of the epinephrine test, acetylcholine esterase inhibitor antibodies and computed tomography findings.

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 Claude Bernard Horner syndrome, the blepharoptosis was unilateral with minimal ptosis and a positive response to neosynephrine. In cases with oculomotor nerve palsy (31 cases) the ptosis was moderate to severe and levator function was poor. In those with myasthenia, the prostigmine test was positive. Levator aponeurotic disinsertion was observed in 16 cases with severe ptosis, positive response to neosynephrine and a high upper crease. There were three cases of trauma-induced ptosis, 5 cases of myopathy and 26 cases of idiopathic ptosis.

The clinical presentation of blepharoptosis is usually related to the etiology. Bilateral blepharoptosis is most often observed in congenital forms, levator disinsertion or idiopathic cases. Male sex predominates in congenital ptosis and oculomotor palsy, and female sex in Claude Bernard Horner syndrome. Moderate to severe ptosis is observed in congenital ptosis or oculomotor palsy. The upper crease is absent in many cases of congenital blepharoptosis and is high in case of levator disinsertion. The response to neosynephrine is positive in Claude Bernard Horner syndrome and aponeurotic disinsertion. The response to prostigmine is positive in case of myasthenia.

Clinical aspects of blepharoptosis are related to etiology. The different features guide surgical or medical treatment of blepharoptosis.