Shining the spotlight on psychogenic ptosis

The rare disorder is often a delayed or misdiagnosed condition, resulting in unnecessary referrals and imaging.

Tiffany Ho, MD, and colleagues from the John F. Hardesty, MD, Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, investigated the rare disorder of psychogenic ptosis and suggested that patient reassurance may be the most appropriate path to resolution.

In their retrospective study, they focused on identifying the clinical parameters, etiology, psychological, and clinical aspects of psychogenic ptosis.

The investigators reviewed the medical records of patients seen between 1990 and 2020 for the patient demographics, including psychiatric history, clinical findings, diagnostic studies, treatment, and resolution rates.

A total of 6 patients, all female, aged 14 to 60 years of age were identified who had been diagnosed with unilateral psychogenic ptosis. In all cases, the patients had sustained a physical injury before the onset of the ptosis.

Ho pointed out that imaging had been performed for all patients, and none had been diagnosed correctly at referral. The associated signs observed were “concurrent brow ptosis, orbicularis oculi spasm, squint on upgaze, and variable levator function and eyelid margin measurements.”

Four of the 6 patients had preexisting psychological conditions. Patients were managed primarily with reassurance, the investigators reported.

Ho and colleagues concluded, “Psychogenic ptosis is an often delayed or misdiagnosed condition, resulting in unnecessary referrals and imaging. Psychogenic ptosis should be considered in patients with atypical findings of ptosis including ipsilateral brow depression, orbicularis oculi spasm, squint on upgaze, and variable eyelid measurements.”

They also pointed out that a previous minor trauma and female sex were common in their study and that partial/complete resolution can be achieved by reassuring the patients. They recommend that clinicians have a low threshold for psychiatric or psychological evaluation, considering the number of patients with comorbid psychiatric conditions.

Reference
  1. Ho TC, Couch SM, Custer PL. Psychogenic ptosis. Ophthal Plast Reconstr Surg. 2022; published online March 23, 2022; doi: 10.1097/IOP.0000000000002157