Ptosis

What is it?

Droopy upper lid
Many causes, including congenital levator muscle weakness, trauma or inflammation of upper lid, myasthenia gravis, third nerve palsy, Horner syndrome, aging weakness of levator tendon

Clinical features may allow distinction of one cause of ptosis from another, for example...
Congenital ptosis is present from birth, has inelastic lid tissue that does not allow normal elevation or depression
Traumatic ptosis follows cuts and blows to upper lid
Contact lens-induced ptosis follows long-term contact lens wear, especially with hard or gas permeable lenses and with history of lid inflammation
Inflammatory ptosis follows infections and allergies of lid skin, conjunctiva, and orbit
Myasthenic ptosis fluctuates and is often accompanied by diplopia and weakness of limbs, speech, chewing, and swallowing
Third nerve palsy ptosis comes with diplopia, reduced eye movements, ocular misalignment, and larger pupil on side of ptosis
Horner syndrome ptosis is typically mild and comes with smaller pupil on side of ptosis ("anisocoria")
Aponeurotic (aging) ptosis is slowly progressive, mild, symmetric in two eyes, and displays elevated upper lid crease

Blepharospasm, or contraction of orbicularis oculi muscle, BUT...blepharospasm is usually intermittent, lowers brow, and raises lower lid
Hemifacial spasm, like blepharospasm, except unilateral
Post-paretic facial contracture, a fixed abnormality that follows facial palsy, BUT...also raises lower lid
Blepharochalasis (or dermatochalasis), redundant skin of upper lid caused by aging or inflammatory stretching, BUT...redundant skin can be lifted to reveal normal level of upper lid margin
Upper lid swelling from inflammation or tumor, BUT...lid is usually deformed and sensitive to touch
Upward displacement of eye, giving false impression that ipsilateral upper lid is lower, BUT...patient will usually have diplopia or proptosis or enophthalmos
Lid retraction, giving false impression that contralateral upper lid is lower, BUT...lid retraction usually accompanied by lid lag