[Differential diagnosis of ptosis (author's transl)]

An accurate differential diagnosis of ptosis results if one refers the functional disorders of the levator to the different levels of the motor unit: Muscle, synapsis, peripheral neuron and nucleus. Therefore ptosis can be classified into myogenic, synaptogenic and neurogenic forms. This classification is also based on electromyographic findings from the levator muscle. Myogenic forms of the ptosis are: Senile ptosis, chronic progressive ocular muscle dystrophy, acute exophthalmic myositis and affections of the levator together with general systemic myopathies. Synaptogenic forms of ptosis are: Botulism and myasthenia gravis. Neurogenic forms of ptosis are: Cortical ptosis, ptosis from lesions of the oculomotor nucleus (congenital ptosis, Moebius-syndrome), peripheral oculomotor palsy, ptosis in aberrant third nerve regeneration, sympathetic ptosis (Horner-syndrome), ptosis in cases of paradoxic innervation such as the Duane retraction-syndrome and the Marcus-Gunn-Jaw-Winking-syndrome (ptosis linked with jaw movement). According to the classification in myogenic, synaptogenic and peripheral-neurogenic forms of ptosis, the therapeutic possibilities (medical, surgical etc.) are discussed.