pseudoptosis

Pseudoptosis is the appearance of upper eyelid droop that resembles true ptosis but results from factors other than weakness of the eyelid levator muscle. In pseudoptosis the levator palpebrae superioris and Müller's muscle have normal function, and eyelid opening can improve with targeted maneuvers. Clinically, distinction from true ptosis relies on examination of levator function, margin reflex distance (MRD1), and the effect of lifting the eyelid skin or brow.

Common causes include dermatochalasis (excess upper eyelid skin) that drapes over the lid margin, and brow ptosis (drooping of the eyebrow) that reduces upper lid crease. Other contributors can be periorbital edema, eyelid masses, or globe protrusion, all of which can alter lid position without true levator dysfunction. These conditions create an apparent ptosis without true eyelid muscle weakness.

Evaluation involves measuring MRD1 and levator excursion in primary gaze, and testing whether elevating the brow or lifting the skin changes lid height. Improvement with manual brow or skin elevation supports pseudoptosis.

Management is directed at the underlying cause. Dermatochalasis is commonly treated with upper blepharoplasty; brow ptosis may require a brow lift or forehead procedures. In some cases, combined procedures are used. Treatment of associated orbital or systemic conditions is also considered.

Prognosis is generally favorable with appropriate diagnosis and treatment, leading to improved eyelid position and cosmetic or functional outcomes.