Differential Diagnosis for Isolated Ptosis
- Single most likely diagnosis
- Aging or Senile Ptosis: This is the most common cause of isolated ptosis, resulting from the stretching or disinsertion of the levator aponeurosis due to aging.
- Other Likely diagnoses
- Congenital Ptosis: Present at birth, often due to underdevelopment of the levator muscle or its nerve supply.
- Aponeurotic Ptosis: Results from disinsertion or stretching of the levator aponeurosis, often seen after cataract surgery or other ocular surgeries.
- Myogenic Ptosis: Caused by weakness of the levator muscle, which can be due to various myopathies or muscular dystrophies.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Third Cranial Nerve Palsy: Although less common, this can cause ptosis and is often associated with other symptoms like diplopia and pupillary dilation. It can be a sign of an aneurysm or other serious intracranial pathology.
- Horner Syndrome: Characterized by mild ptosis, miosis, and anhidrosis, it can be a sign of a serious underlying condition such as a stroke, carotid artery dissection, or a tumor affecting the sympathetic pathway.
- Rare diagnoses
- Chronic Progressive External Ophthalmoplegia (CPEO): A mitochondrial myopathy that leads to progressive weakness of the external eye muscles, including the levator palpebrae superioris, causing ptosis.
- Oculopharyngeal Muscular Dystrophy: A rare genetic disorder that affects the muscles of the eyes and throat, leading to ptosis and dysphagia.
- Levator Muscle Fibrosis: A rare condition where the levator muscle becomes fibrotic, leading to ptosis.