Brow Ptosis

A constricted visual field made it difficult for an 80-year-old man to see to the side while driving (A). He had recently undergone successful cataract surgery; his visual acuity was normal in both eyes.

Confrontation visual field testing was performed. This requires the patient to be seated directly opposite the clinician and to cover one eye at a time. The clinician brings his or her fingers in from above and observes the level at which the patient first sees the fingers; any constriction is noted. This test identified superior and temporal constriction. Manually lifting the eyebrows (B) relieved the visual field constriction and, the patient reported, “brightened up the vision.”

This patient had mild dermatochalasis; however, it was the brow ptosis that affected his superior and temporal visual field. Eyebrow laxity and ptosis that develop with aging can be attributed to the progressive laxity of the scalp and forehead soft tissues. This process is aggravated by gravity and causes a narrowing of the palpebral fissure that results in pseudoptosis of the eyelids.

A blepharoplasty with a brow lift improved this patient's visual field.