Evaluating eyelid function in upper eyelid ptosis Measuring Eyelid Function and Ptosis (droopy upper eyelid)

Upper eyelids need to protect the eye yet get out of the way for vision. Explore plastic surgery for the eyelid for both reconstructive and cosmetic (blepharoplasty) problems.

Michael Bermant, MD
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Upper eyelid ptosis and plastic surgery correction of the drooping eyelid
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Upper eyelid drooping simple congenital ptosis with levator muscle shortening
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Function:

The eyelid lifting can come from its own (levator, and Muller's) muscles, and from the forehead (frontalis) muscle.

Ptosis is the the distance the eyelid is below its normal position. At rest, the lid is just below the top part of the iris (the colored part of the eye.) This is measured with the patient looking straight forward with the head vertical.

Amount Ptosis Classification
less than or equal to 2mm Mild
3mm Moderate
greater than or equal to 4mm Severe

In this patient with congenital ptosis, the right eye had been operated on as a child. Even in direct ahead gaze, the forehead muscles were needed to barely keep the lids up out of the way of the pupils for vision. Looking up, it is clear this patient could not see.

Patient with drooping upper eyelid.
Overworking of frontalis muscle in congenital eyelid ptosis

Photograph before surgery with the patient looking straight ahead

Photograph before surgery with the patient looking up. The forehead muscles are helping.

Levator function is measured by blocking the effect of the forehead, in this case with a thumb. The ruler permits measurement of the extent of eyelid movement on maximum down and up gaze.

evaluating levator muscle function blocking frontalis muscle in eyelid ptosis
Another image where Dr. Bermant is blocking frontalis muscle to evaluate levator muscle function in congenital ptosis.

Photograph with this patient looking down, a ruler is used to measure the motion of the eyelid with the forehead muscles blocked.

Photograph with the patient looking up with the thumb blocking the frontalis forehead muscle's contribution to the eyelid.

Eyelid function does not need to be the same on each eye. Both need to be measured.

Blocking frontalis muscle to evaluate levator muscle function in congenital ptosis.
Another image where Dr. Bermant is blocking frontalis muscle to evaluate levator muscle function in congenital ptosis.

Picture of patient looking up and the right forehead muscles blocked.

Picture of patient looking up and the left forehead muscles blocked.

Treatment for congenital ptosis depends on the degree of function of the levator muscle.

Levator Muscle Excursion Classification
15mm Normal
greater than or equal to 8mm Good
5-7mm Fair
less than or equal to 4mm Poor

 

This patient's measurements Right Left
Preoperative Ptosis 4mm 3mm
Levator Function 5mm 7mm

 

See other photographs of this patient before and after surgery.

Back Eyelid Ptosis - droopy upper eyelids.Forward Eyelid Ptosis - droopy upper eyelids.

Other topics of interest:

Ptosis of the eyelid (dropping of the upper eyelid).
Upper eyelid ptosis and drooping eyelid.
Ptosis classification 
Muscle function and dysfunction in drooping eyelid problems.
Upper eyelid ptosis with frontalis muscle compensation.
Measuring eyelid function in eyelid ptosis.
Testing levator muscle for drooping eyelid
Congenital eyelid ptosis reconstructive surgery options. 
Recurrent congenital eyelid ptosis in a 26 year old black male.
Frontalis muscle compensation in drooping eyelid
Ptosis associated with paralyzed eyebrow muscle.
brow ptosis creating droopy eyelid
Ptosis associated with Blepharophimosis (congenital eyelid deformity).
eyelid ptosis
Blepharoplasty (Cosmetic surgery of the eyes)
eyelid

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Facelift / Neck lift (rhytidectomy)

Eyelid surgery in Richmond Virginia

Ptosis of the eyelid (drooping of the upper eyelid)

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This page last updated on: April 21, 2012

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