Management of myogenic (myopathic) ptosis

In senile ptosis and late-acquired hereditary ptosis, the Fasanella-Servat procedure is dependable and successful. However, levator resection by the posterior approach is appropriate for the more severe problems. In senile ptosis, a search should be made for signs that might prompt disinsertion repair. The decision for surgery in patients with chronic progressive external ophthalmoplegia or myotonic dystrophy should be made cautiously, and the "optical tarsectomy" should be considerable before conservative levator resection or fascia lata suspension. The patient with myasthenia gravis should be identified, medical evaluation initiated, and except in rare instances, surgery avoided. The more unusual forms of myogenic ptosis should be treated surgically only when the ptosis persists and has stabilized.