Acquired Ptosis in the Young and Middle-aged Adult Population

Purpose: The authors studied the etiology of acquired ptosis in the young to middleaged adult population with specific attention to the role of rigid contact lens use. Methods: The study consisted of all patients between the ages of 15 and 50 years with acquired ptosis who presented between April 1986 and May 1994. Potential factors responsible for acquired ptosis were investigated in all patients with specific attention directed to history and duration of contact lens wear. Results: In the consecutive series of 91 young to middle-aged adults with acquired ptosis, we found contact lens wear to be the only identifiable cause in 47% of patients. This was the most common cause for acquired ptosis in this age group. Trauma was a distant second cause, accounting for 19% of patients. Of the contact lens-induced ptoses, 58% were unilateral and 42% were bilateral. Of the 25 patients who wore contact lenses and had unilateral ptosis on examination, manual elevation of the ptotic lid showed an unsuspected contralateral ptosis to be manifest in seven patients due to Hering's law. Ptosis was overwhelmingly associated with rigid contact lens wear, and levator aponeurosis disinsertion was found in the large majority at the time of surgical repair. Conclusion: This study suggests that contact lens-induced ptosis is a much more common cause of acquired ptosis in young and middle-aged adults than has been suspected previously. The ptosis is primarily due to levator aponeurotic disinsertion, presumably due to recurrent traction on the aponeurosis during rigid contact lens removal.