A Community Survey of Ptosis of the Eyelid and Pupil Size of Elderly People

A randomly selected, age-stratified sample of subjects 50 years of age and older, living in the Salford Health District area of Greater Manchester was drawn from the age-sex register of a four-doctor group practice and invited by post to enter a study of ptosis. Of 851 subjects approached, 499 (59%) replied. Of these, 99 refused to participate. The remaining 400 were visited at home and underwent a standardized protocol of ophthalmic history, and examination including a photograph of the eyes in the primary position. Forty-six (11.5%) of the subjects had ptosis and its prevalence increased with age. Ptosis was bilateral in 18 (39%) and unilateral in 28 (61%). In all but four cases, the ptosis was acquired. The cause was evident in 23 (50%), with 11 cases being due to mechanical ptosis and 12 to aponeurotic disinsertion secondary to a known pathology. A further 22 cases had primary aponeurotic disinsertion and there was one case of probable myasthenia gravis. The prevalence of pupillary diameter of 1 mm or less increased significantly with age.