Myogenic Ptosis and Muscular Dystrophy: When Drooping Eyelids Signal an Underlying Muscle Condition

Drooping eyelids, known medically as ptosis, are often associated with aging or localized eyelid changes. However, in some individuals, ptosis reflects an underlying neuromuscular disorder. One important and less commonly discussed cause is myogenic ptosis related to muscular dystrophies, a group of inherited conditions that impair muscle structure and function throughout the body.

For people living in Red Bank and throughout Monmouth County, recognizing when drooping eyelids may be part of a larger muscle condition is important. Management focuses not only on the eyelids themselves, but also on the systemic disease process driving the muscle weakness and on everyday visual comfort.

What Is Myogenic Ptosis?

Myogenic ptosis occurs when the muscle responsible for lifting the eyelid, the levator palpebrae superioris, is weakened due to a primary muscle disorder. Unlike nerve-related or mechanical ptosis, the issue lies within the muscle fibers themselves.

Muscular dystrophies most commonly associated with eyelid drooping include oculopharyngeal muscular dystrophy (OPMD) and myotonic dystrophy. These conditions typically produce slowly progressive, often bilateral ptosis that worsens over time. Patients may experience:

• Difficulty keeping their eyes open, especially later in the day
• Needing to tilt the head back or raise the eyebrows to see better
• Swallowing difficulty
• Facial weakness or a “tired” appearance
• Generalized muscle fatigue or weakness in other areas of the body

From a documentation standpoint, eye care and medical teams may use ICD-10 codes such as G71.09 (other specified muscular dystrophies), G71.11 (myotonic muscular dystrophy), and H02.40–H02.409 for associated eyelid ptosis, depending on laterality and documentation. These codes help coordinate care and insurance documentation, but the clinical focus remains on comfort, vision, and safety.

How Muscular Dystrophy Affects the Eyes

In muscular dystrophies, genetic abnormalities disrupt normal muscle protein function. Over time, muscle fibers weaken and degenerate. When the levator muscles are involved, the eyelids gradually lose their ability to remain elevated, leading to drooping that may interfere with vision.

Myogenic ptosis is often:

• Relatively symmetrical between the two eyes
• Slowly progressive over months or years
• Associated with reduced levator muscle strength
• Less responsive to voluntary “effort” to open the eyes wider

Because muscular dystrophies are systemic disorders, eyelid findings often occur along with other neurologic or muscular signs. This makes interdisciplinary care essential, with eye care providers working closely with neurology and primary care teams.

Diagnosis and Coordinated Care

Evaluation of suspected myogenic ptosis includes careful eyelid measurements, assessment of levator function, blink quality, and ocular surface health. At Crystal Eyecare, this is performed as part of a detailed eye examination that looks at both eyelid position and overall visual function.

When muscular dystrophy is known or suspected, coordination with other healthcare providers is important, including:

• Neurologists or neuromuscular specialists
• Primary care physicians
• Genetics and rehabilitation professionals, when appropriate

Genetic testing and electrophysiologic studies are typically managed by medical specialists, while eye care focuses on maintaining vision, comfort, and corneal safety. Regular communication among providers helps ensure that changes in eyelid function and overall muscle health are monitored over time.

Treatment Options for Myogenic Ptosis

Management is individualized and aims to balance visual improvement against the risk of exposure-related eye surface problems. The best plan depends on the severity of ptosis, general health, daily visual demands, and the specific type of muscular dystrophy.

Surgical intervention, such as frontalis suspension, may be appropriate for selected patients. Surgery must be approached cautiously because weakened eyelid closure can increase the risk of:

• Dryness
• Ocular irritation
• Corneal damage if the eye surface is not adequately protected

Long-term outcomes in muscular dystrophy patients can vary, and repeat interventions may sometimes be necessary as muscle function changes. For many individuals, especially those who are not ideal surgical candidates, non-surgical management plays a central role.

The Role of Ptosis Crutches

One valuable non-surgical option is the use of ptosis crutches. These are small mechanical supports attached to eyeglass frames that help lift the eyelids into a more functional position without altering the eyelid itself.

Ptosis crutches can:

• Improve visual field obstruction by lifting the eyelid out of the line of sight
• Reduce eyelid fatigue and the constant effort to keep the eyes open
• Delay or, in some cases, avoid eyelid surgery
• Provide adjustable, reversible support as symptoms evolve

For patients with muscular dystrophy, ptosis crutches are often used as a long-term solution or as a bridge while symptoms and available medical treatments change over time. Proper fitting is essential to ensure comfort, maintain as natural a blink as possible, and minimize ocular surface irritation.

At Crystal Eyecare, we offer custom ptosis crutches and frame modifications tailored to each patient’s eyelid position, frame style, and visual needs. Many patients find that this simple mechanical solution can make daily tasks like reading, computer work, and driving more manageable.

Looking Ahead

Research into muscular dystrophies continues to advance. Emerging therapies, including gene-based treatments and antisense oligonucleotides, aim to address the underlying muscle pathology. While these treatments are still developing and may not be appropriate or available for every patient, they hold promise for improving muscle function and potentially reducing the severity of ptosis in the future.

Until disease-modifying therapies become widely available, supportive eye care remains a cornerstone of management. Regular eye examinations can help monitor:

• Changes in eyelid position and function
• Ocular surface health and dryness
• Visual needs related to work, school, and daily activities

How Crystal Eyecare in Red Bank, NJ Can Help

At Crystal Eyecare, we recognize that ptosis is not merely a cosmetic concern. When eyelid drooping is linked to muscular dystrophy, thoughtful and individualized care is essential. Our team in Red Bank, New Jersey works closely with patients and their medical providers to help preserve vision, comfort, and quality of life.

Our role may include:

• Comprehensive eye and eyelid evaluation
• Recommendations for lubrication, lighting, and visual ergonomics
• Discussion of non-surgical options, including ptosis crutches and frame modifications
• Ongoing monitoring of corneal health and eyelid function
• Coordination with neurology and primary care when appropriate

If you or a loved one has muscular dystrophy and is experiencing drooping eyelids or visual fatigue, our team is here to help guide you through your options and support your daily visual function.

References

1. Allen RC, et al. Primary bilateral silicone frontalis suspension for good levator function ptosis secondary to oculopharyngeal muscular dystrophy. British Journal of Ophthalmology. 2012. Available at: PubMed
2. Allen RC, et al. Full text: Primary bilateral silicone frontalis suspension for ptosis secondary to OPMD.
   British Journal of Ophthalmology. Available at: Full article (PDF)
3. EyeWiki. Oculopharyngeal Muscular Dystrophy. Available at: https://eyewiki.org/Oculopharyngeal_Muscular_Dystrophy
4. EyeWiki. Ocular Manifestations of Myotonic Dystrophy. Available at: https://eyewiki.org/Ocular_Manifestations_of_Myotonic_Dystrophy
5. Abdulrauf BM, et al. Frontalis suspension in muscular dystrophy: long-term outcomes. 2022. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8939913/

This article is intended for educational purposes only and does not provide medical advice or diagnosis.
If you notice new or worsening drooping of one or both eyelids, or have concerns about muscular dystrophy or other neuromuscular conditions,
please consult a qualified eye care professional and your medical team.
For sudden vision loss, severe eye pain, or new neurological symptoms, seek urgent or emergency care right away.