Skip to main content

Neurogenic Blepharoptosis

  • Chapter
  • First Online:
Evaluation and Management of Blepharoptosis

Abstract

Neurogenic blepharoptosis is an important entity to recognize since there are specific considerations in its evaluation and treatment. Most cases are caused by lesions of the oculomotor nerve or a disruption of the oculosympathetic pathway. Neurogenic ptosis can be distinguished from involutional blepharoptosis by the associated findings of pupillary and/or ocular motility abnormalities. The etiology and localization of the lesion is determined by a careful review of the history, associated signs and symptoms, and appropriate neuroimaging studies. The initial treatment approach is aimed at correcting the underlying pathologic process. For patients who require surgical repair of the ptosis, frontalis sling is the only viable option for patients with oculomotor nerve palsy, while both levator resection and Müllerectomy are effective procedures for patients with Horner syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 189.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Caplan LR. Cerebral ptosis. J Neurol Neurosurg Psychiatry. 1974;34:1–7.

    Article  Google Scholar 

  2. Averbuch-Heller L, Leigh RJ, Mermelstein V, Zagalsky L, Streifler JY. Ptosis in patients with hemispheric strokes. Neurology. 2002;58:620–4.

    Article  CAS  PubMed  Google Scholar 

  3. Krohel GB, Griffin JF. Cortical blepharoptosis. Am J Ophthalmol. 1978;85:632–4.

    Article  CAS  PubMed  Google Scholar 

  4. Boghen D. Apraxia of eyelid opening: a review. Neurology. 1997;48:1491–4.

    Article  CAS  PubMed  Google Scholar 

  5. Lepore FE, Duvoisin RC. “Apraxia” of eyelid opening: an involuntary levator inhibition. Neurology. 1985;35:423–7.

    Article  CAS  PubMed  Google Scholar 

  6. Jordan DR, Anderson Rl, Digre K. Apraxia of lid opening in blepharospasm. Ophthalmic Surg. 1990;21:331–4.

    CAS  PubMed  Google Scholar 

  7. Richards BW, Jones FR, Younge BR. Causes and prognosis in 4278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992;113:489–96.

    Article  CAS  PubMed  Google Scholar 

  8. Carter SR, Meecham WJ, Seiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications­ and efficacy. Ophthalmology. 1996;103(4):623–30.

    Article  CAS  PubMed  Google Scholar 

  9. Kardon RH, Denison CE, Brown CK, Thompson HS. Critical evaluation of the cocaine test in the diagnosis of Horner’s syndrome. Arch Ophthalmol. 1990;108:384–7.

    Article  CAS  PubMed  Google Scholar 

  10. Koc F, Kavuncu S, Kansu T, Acaroglu G, Firat E. The sensitivity and specificity of 0.5% apraclonidine in the diagnosis of oculosympathetic paresis. Br J Ophthalmol. 2005;89(11):1442–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Brown SM, Aouchiche R, Freedman KA. The utility of 0.5% apraclonidine in the diagnosis of horner syndrome. Arch Ophthalmol. 2003;121(8):1201–3.

    Article  PubMed  Google Scholar 

  12. Morales J, Brown SM, Abdul-Rahim AS, Crosson CE. Ocular effects of apraclonidine in Horner syndrome. Arch Ophthalmol. 2000;118:951–4.

    CAS  PubMed  Google Scholar 

  13. Cremer SA, Thompson HS, Digre KB, Kardon RH. Hydroxyamphetamine mydriasis in Horner’s syndrome. Am J Ophthalmol. 1990;110:71–6.

    Article  CAS  PubMed  Google Scholar 

  14. Maloney WF, Younge BR, Moyer NK. Evaluation of the causes and accuracy of pharmacologic location of Horner’s syndrome. Am J Ophthalmol. 1980;90:394–402.

    Article  CAS  PubMed  Google Scholar 

  15. Kline LB, Vitek JJ, Raymon BC. Painful Horner’s syndrome due to spontaneous carotid artery dissection. Ophthalmology. 1987;94:226–30.

    Article  CAS  PubMed  Google Scholar 

  16. Jeffery AR, Ellis FJ, Repka MX, Buncic JR. Pediatric Horner syndrome. J AAPOS. 1998;2:159–67.

    Article  CAS  PubMed  Google Scholar 

  17. Watts P, Satterfirld D, Lim MK. Adverse effects of apraclonidine used in the diagnosis of Horner syndrome in infants. J AAPOS. 2007;11(3):282–3.

    Article  PubMed  Google Scholar 

  18. George ND, Gonzalez G, Hoyt CS. Does Horner’s syndrome in infancy require investigation? Br J Ophthalmol. 1998;82:51–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Musarella MA, Chan HS, DeBoer G, Gallie BL. Ocular involvement in neuroblastoma: prognostic implications. Ophthalmology. 1984;91:936–40.

    Article  CAS  PubMed  Google Scholar 

  20. Mahoney NR, Liu GT, Menacker SJ, Wilson MC, Hogarty MD, Maris JM. Pediatric Horner syndrome: etiologies and roles of imaging and urine studies to detect neuroblastoma and other responsible mass lesions. Am J Ophthalmol. 2006;142:651–9.

    Article  PubMed  Google Scholar 

  21. Glatt HJ, Putterman AM, Fett DR. Müller’s muscle-conjunctival resection procedure in the treatment of ptosis in Horner’s syndrome. Ophthalmic Surg. 1990;21(2):93–6.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jonathan W. Kim .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Kim, J.W. (2011). Neurogenic Blepharoptosis. In: Cohen, A., Weinberg, D. (eds) Evaluation and Management of Blepharoptosis. Springer, New York, NY. https://doi.org/10.1007/978-0-387-92855-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-92855-5_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-92854-8

  • Online ISBN: 978-0-387-92855-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics