Levator Dehiscence (aponeurotic ptosis)

 

Left ptosis with high skin crease. Right ptosis with high skin crease.

The patient has a high skin crease in the ptotic eye. The levator function is otherwise good.The condition may be bilateral in involutional (senile) cases. The skin above the tarsal plate is thin and may appear semi-transparent (especially in the elderly). The pupil and the ocular motility are normal unless the cause is traumatic. Look for: pseudophakia in the affected eye. The ptosis may be due to trauma to the superior rectus-levator complex during superior recuts bridal suturing.

Questions:

1. What are the causes of levator dehiscence?

answer
involutional (senile)
trauma as in post-surgery as in superior rectus bridal suture
blepharochalasis which is an idiopathic, recurrent, non-pitting oedema of the upper lid

2. What is responsible for the skin crease?

answer
It is formed by the attachment of the levator aponeurotic to the skin.

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