Involutional ptosis: recognition and management.

Involutional ptosis is a ptosis of varying degree. There is good levator function with a high lid fold and increased lid excursion on downgaze. There may be increased translucency of the upper lid. We reviewed all adult ptosis cases over the past three years at Sydney Eye Hospital and found 20 cases to have aponeurotic defects such as a dehiscence or disinsertion. Ninety percent of our cases had a positive 10% phenylephrine test. We recommend that all operations be done under local anaesthesia without adrenaline, overcorrecting by 1-2 mm at the time of surgery.