JMR Lamina, Hanif & Ahmad, 2007

INCIDENCE AND AETIOLOGICAL FACTORS OF PTOSIS IN A

NIGERIAN SPECIALIST HOSPITAL
*LAMINA S, **HANIF MS & ***AHMAD RY
*Department of Physiotherapy, Faculty of Medicine, Jimma University, Jimma, Ethiopia.
**Department of Physiotherapy, Murtala Mohammad Specialist Hospital, Kano.
***Department of Physiotherapy, Bayero University, Kano.

Abstract
Introduction: Epidemiological data on ptosis are generally lacking in the developing nations.
Objective: The aim of this study was to assess the five years incidence and aetiological factors of ptosis in a Nigerian
Specialist Hospital.
Method: The records of patients’ diagnosis as ptosis between 2001 and 2005 were scrutinized. Data such as age, sex,
cause, socioeconomic status, side of ptosis and management were obtained.
Result: A total number of 104 patients were recorded. High prevalence was found as follows: (1) gender: male (69%);
(2) side: right side (64%); (3) cause: trauma (RTA) (60%); (4) socioeconomic status: students (28.8%) followed by
civil servants (23.1%); (5) age group: 51-60 years (25%).

Key Words: Ptosis; Prevalence; Causes; Incidence.

Correspondence: Lamina S, Department of Physiotherapy, Faculty of Medicine, Jimma University, Jimma,
Ethiopia.
Ph: 009-251471123021; e-mail: siklam_86@yahoo.co.uk

Introduction particularly the use of electrical stimulator in the

Ptosis means drooping of the upper eyelid
and is usually due to paralysis of the levator
palpebrae superioris (supplied by the third cranial
nerve) or paralysis of the orbital smooth muscles
(supplied by the sympathetic nerve). Paralysis of the
levator palpebrae superioris causes complete ptosis,
while that of sympathetic nerve causes partial ptosis1.
Ptosis due to third cranial nerve and
sympathetic nerve palsy is usually unilateral, unless a
situation occurs whereby the nerves on both sides of
the body are paralysed at the same time. Other causes
might be due to injury, diabetes, tumour, Horner’s
syndrome, Ophthalmoplegia, inflammation or
aneurysms. Bilateral ptosis is often due to
myasthenia gravis, myoneural junction disease, such
as botulism, primary disease of the muscles with
muscular dystrophy and congenital ptosis1-2.
Many people want to correct ptosis because
it damages their appearance, in most cases, the
sagging upper eyelid results in a loss of the superior
(upper) field of vision. Generally, literature seems
scanty on the prevalence of ptosis and there have
been no studies on the prevalence and aetiology of
ptosis in Nigeria. Therefore, the purpose of this study
was to remedy the deficiency in literature by
determining the prevalence and aetiology of ptosis in
a Nigerian Specialist Hospital. It is believed that the
outcome of this study will sensitize the clinicians,
ophthalmologist and physical therapist to initiate
studies on noninvasive physical management
management of ptosis. Furthermore, the outcome of
this study will provide baseline data which could be
used in future studies.
Patients/Methods
This study was carried out in Murtala
Mohammad Specialist Hospital (MMSH), Kano,
North-West Nigeria. The hospital was established in
1927 and has been the solely core hospital serving
patients from both metropolitan and rural areas as
well as some neighboring states (Bauchi, Jigawa,
Katsina and Kaduna) and some nearby foreign
countries such as Niger and Cameroon. The hospital
also serves as a referral centre for other established
government hospitals and private health
establishments within and outside the state.
The records of patients diagnosed as ptosis
during the period of five years (2001-2005) were
obtained from the statistical unit of the medical
record of the hospital. Data collected from the
patients’ files include the following: age, sex,
aetiology of ptosis, side of ptosis, socioeconomic
status (occupation), treatment given and referral for
physiotherapy. Descriptive analysis was used to
analyse the data.
Results
A total of 104 ptosis patients were recorded
between year 2001 and 2005. 72 (69%) males and 32
(31%) females; 66 (64%) had right ptosis, 34 (32%)
had left ptosis, while the remaining 4 (4%) presented
with bilateral ptosis. The major aetiological factor

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Lamina, Hanif & Ahmad, 2007
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was trauma sustained in road traffic accident (RTA) ptosis (N=104)

62 (60%) followed by Ophthalmoplegia 26 (24.6%) Table 4: Five years (2001-2005) distribution pattern
and 6 (5.8%) was as a result of diabetes mellitus
(Table 1). Year (Jan – Dec) No of cases (%)
2005 39 (37.5)
Table 1: Aetiological distribution of ptosis during
2004 25 (24.0)
the period 2001-2005 (N=104)
2003 19 (18.3)
Causes No of Cases 2002 13 (12.5)
Trauma (RTA) 62 (60%) 2001 8 (7.7)
Ophthalmoplegia 26 (24.6%) Total 104 (100)
Diabetes mellitus 6 (5.8%) of incidence of ptosis (N=104)
Congenital 5 (4.8%)
No specific/associated cause 5 (4.8%) Discussion
Total 104 (100%) The study revealed increased prevalence of
ptosis with age; this is in agreement with the finding
The result showed an increase with age of Sridhavan et al3. The increased prevalence of
(table 2), the age groups of the patients as recorded ptosis with age in the present study could be linked
were as follows: < 1 year (4.0%), 2-10 years (6%), with the study carried out by Charlotte and Stuart4
11-20 years (15.0%), 21-30 years (23.0%) and 51-60 which states that the susceptibility of chronic
years (27.0%). The incidence of ptosis as shown in diseases increase with age; this increase is a
table 3 was highest among students (28.8%) followed reflection of both physiological changes and
by civil servants (23.1%), while under care was the cumulative environmental and genetic risk factor
least (5.8%). The result showed a steady increase in exposure. Results of the present study also showed
the incidence of ptosis from 2001 (7.7%) to 2005 that males have higher incidence of ptosis. Trauma
(37.5%) (Table 4). The major treatment given to the (RTA) was recorded as the highest aetiological factor
patients was chemotherapy (100%) while about 90% in Nigeria. The work of Sridhavan et al3 revealed a
were referred for physiotherapy. None of the cases contrary report. They reported mechanical injury as
recorded were referred for surgery, also ophthalmic the main aetiological factor of ptosis in Manchester
crutches were not available neither were they (England). In the present study, the incidence of
prescribed. ptosis was highest among students followed by civil
servants; also, the highest incidence of ptosis was
Table 2: Age distribution of ptosis during the period recorded in the year 2005.
Age group (years) No of cases (%) The reasons for high incidence of ptosis in
<1 4 (4) males, students and civil servants, and in the year
1 – 10 6 (6) 2005 may be linked to the high incidence of
11 – 20 16 (15) traumatic ptosis in RTA which could be as a result of
21 – 30 24 (23)
annual increase in the number of commercial motor
cyclists popularly called “Achaba” or “Okada” in
31 – 40 16 (15)
Nigeria specifically Kano city transport system.
41 – 50 10 (10)
These categories of people (students, civil servants
51 – 60 28 (27) and males) are the most mobile and most patronage
Total 104 (100) of these commercial motor cyclists for transportation.
of 2001-2005 (N=104) The present study revealed high incidence of
unilateral ptosis (96%); this concur with the report of
Table 3: Socioeconomic status and incidence of Sridhavan et al3, they reported about 61% unilateral
ptosis in Manchester. The high incidence of right
Socioeconomic Status No of Cases (%) ptosis reported in the present study may be attributed
Student 30 (28.8) to the fact that most people are right handed and
Civil servant 24 (23.1) there is high possibility for the right handed persons
Trader 14 (13.5) to fall on the right side/head in RTA or any incidence
Farmer 12 (11.5) of fall.
Full house wife 10 (9.6) Doctors as found out in this study referred
Unemployed (Idle) 8 (7.7) most of the patients for physical therapy. Reasons for
Under care 6 (5.8) their referral have no literature backup because
Total 104 (100)
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presently there is dearth of data on physical therapy
management of ptosis but one could link their
referral to the fact that physical therapy management
of facial and Bell’s palsy has been well established5-6.
They found it logical to refer similar paralysis (ptosis)
for physical therapy. Also, after a long term drug
prescription all to no avail coupled with
unavailability of facilities for surgery and ptosis
crutches within the country and the cost of
management abroad may be too enormous for the
patient, they found it reasonable to leave the patient
to the mercy of physical therapy.
References
1. Lumley JSP. Hamilton Bailey’s Physical Signs
Demonstration of Physical Signs in Clinical
Survey, 18th ed. Oxford: Butterworth Heinemann,
1997.
2. Falase AO, Akinkugbe O. A Compendium of
Clinical Medicine. Ibadan: Spectrum Book
Limited, 2000.
Journal of Medicine and Rehabilitation; Maiden Edition, March/April 2007
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Lamina, Hanif & Ahmad, 2007
3. Sridhavan GV, Tallis RC, Leatherbarrow B,
Forman WM. A community survey of ptosis of
the eyelid and pupil size of elderly people. Age
and Aging 1995; 24: 21-4.
4. Charlotte ER, Stuart GP. Molecular genetics and
age related disease. Age and Aging 2001; 30:
449-54.
5. Ayanniyi O, Akinpelu AO. The use of ultrasound
in the management of Bell’s palsy: Case studies.
Journal of the Nigerian Society of Physiotherapy
1992; 11 (2): 31-4.
6. Lamina S, Hanif S. Physiotherapy and self
concept in the management of patients with
facial palsy. JMRTB 2005; 10 (18), 42-5.
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