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Myopathic Blepharoptoses

A New Classification System

Burnstine, Michael M.D.*,†; Greer, Christine M.D., M.S.*; Lee, Diana K. M.D.*; Kim, Jonathan W. M.D.*,‡

Ophthalmic Plastic and Reconstructive Surgery: November/December 2019 - Volume 35 - Issue 6 - p 525–534
doi: 10.1097/IOP.0000000000001405
Major Reviews

Purpose: Myopathic blepharoptoses (ptoses) is a complex group of disorders. To date, no formal categorization scheme has been developed based on associated ocular and systemic findings, genetic fingerprint, treatment, and prognosis for each ptosis in this group. We report a new classification scheme for myopathic ptoses.

Methods: Literature review and classification development.

Results: A new classification scheme of myopathic ptoses includes isolated static myopathic ptosis (congenital ptosis), static myopathic ptosis associated with aberrant innervation and those associated with periocular abnormalities, and progressive myopathic ptoses that affect the levator muscle and other muscle groups in childhood and adulthood.

Conclusions: Making the distinction of myopathic ptosis type early will maximize patient outcomes by optimizing surgical and systemic management and facilitating the recruitment of subspecialists to care for patients with these challenging conditions.

The authors present a comprehensive and effective myopathic ptosis classification scheme to optimize surgical management and facilitate subspecialty care.

*Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, California, U.S.A.

Eyesthetica, Oculofacial and Cosmetic Surgery Associates, Los Angeles, California, U.S.A.

Department of Ophthalmology, The Vision Center, Children’s Hospital Los Angeles, Los Angeles, California, U.S.A.

Accepted for publication April 19, 2019.

In-kind support from a departmental grant from the research to prevent blindness.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Michael A. Burnstine, M.D., 1450 San Pablo Street, Los Angeles, CA 90033. E-mail:


© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.