Downgaze Eyelid Position in Patients with Blepharoptosis

Purpose: To prospectively examine the change in upper eyelid position on downgaze in patients with blepharoptosis. Methods: Upper eyelid margin to corneal light reflex distance (uMRD) was measured in primary gaze and in 30° to 40° downgaze in 50 consecutive patients with acquired ptosis and 10 consecutive patients with congenital ptosis. Results: For the acquired ptosis group, the mean change in uMRD on downgaze was −0.8 mm (range, −2.5 to 1.0 mm), with one patient (2%) showing an increase, 10 (20%) no change, and 39 (78%) a decrease in upper eyelid position. For the congenital group, the mean change in uMRD on downgaze was +2.1 mm (range, 1.0–4.0 mm), with all patients demonstrating an increase in upper eyelid position. The difference between the group means was highly significant (P < 0.001). Conclusions: Worsening of ptosis on downgaze is common with acquired ptosis and likely represents a normal physiologic process, which may exacerbate functional impairment of activities (i.e., reading) in this gaze position. The consistent increase in upper eyelid position on downgaze in patients with typical congenital ptosis is an abnormal differentiating sign.