Management of myogenic ptosis

To review the genetics, clinical features, and management of patients affected by myogenic ptosis.

Retrospective, noncomparative interventional case series.

Twenty-eight patients with myogenic ptosis.

A review of all patients with myogenic ptosis between 1992 and 2000 was made in a tertiary oculoplastics practice.

Ocular and systemic findings associated with myogenic ptosis were examined. Patients were diagnosed clinically, and ancillary tests (including genetic tests and muscle biopsy histologic findings) were reviewed. Surgical management principles and complications are discussed.

Most of our ptosis patients had chronic progressive external ophthalmoplegia (43%), oculopharyngeal muscular dystrophy (OPMD; 18%), and myotonic dystrophy (18%). Fifty percent of myogenic ptosis patients in our series underwent frontalis suspensions. Twenty-one percent of patients who initially had operations at our institution had minor complications, most related to corneal exposure. The most common ocular finding other than ptosis and ophthalmoplegia was pigmentary retinopathy (25%). The most common systemic finding in our patients was dysphagia (43%). Genetic testing for OPMD was highly sensitive. Muscle biopsy results for mitochondrial myopathies were less accurate as adjunctive diagnostic tests.

Myogenic ptosis should be considered in the differential diagnosis of any atypical ptosis presentation. To avoid complications, surgery should be performed only when the visual axis is obscured. We recommend the use of silicone slings in any patient with severe ptosis and less than 8 mm of levator function. Genetic testing of patients with myogenic ptosis is important to allow accurate diagnosis and to permit appropriate counseling on potentially life-threatening health issues.