Purpose: Acquired ptosis has many causes and establishing a diagnosis guides management. It is much less common in the young and no published data exists on the relative frequency of causes in different age groups. We present the epidemiology of acquired ptosis across all age groups.
Method: All patients presenting with acquired ptosis to two ocular plastics specialists (AM and TH) and a paediatric ophthalmologist (JE) over a period up to 25 years were classified according to their diagnosis. Where the diagnosis was uncertain, files were re-examined to try and further establish a cause. Patients were grouped into children (<18 years), younger adults (18 - 40 years) and older adults (>40 years).
Results: A total of 2239 patients were analysed. 119 were children, 264 were younger adults and 1856 were older adults at presentation.
The commonest cause of acquired ptosis in children was trauma (n=32, 26.9%). In 21.8% of cases (n=26), a definite diagnosis could not be made.
The commonest causes in younger adults were trauma (n=75, 28.4%) and anophthalmic ptosis (n=53, 20.1%). In 12.1% of cases (n=32), a definite diagnosis could not be made.
The commonest causes in older adults were aponeurotic or involutional (n=1083, 58.4%) and trauma (n=158, 8.5%). In 6.5% of cases (n=121), a definite diagnosis could not be made.
Conclusion: The cause of acquired ptosis can usually be established by history and examination, with additional diagnostic tests sometimes required. A small percentage of patients have ptosis of unknown cause which does not fit the usual diagnostic categories.