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January 17, 2026<\/p>\n
2 min read<\/p>\n<\/p><\/div>\n
\n \n \n Add topic to email alerts \n <\/span> \n <\/p>\n\n\n \n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nIn patients with ptosis, a large pupil may be indicative of third nerve palsy.<\/li>\nLevator function measurement can help determine the best treatment approach.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 Examining the pupil and performing motility checks are key for effectively managing patients with ptosis and catching underlying conditions, according to a speaker at Hawaiian Eye 2026.<\/p>\n\u201cWhen you think about the eyelid, and ptosis in general, the eyelid always runs with two friends: The pupil and the extraocular muscles,\u201d Andrew R. Harrison, MD,<\/b> <\/b>said. \u201cWhen you see a patient with an eyelid problem, a ptosis, you need to think about these two as well.\u201d<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\nIn patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\nAnother indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n \u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\nAccording to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\nIf the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\nIn patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
\n Receive an email when new articles are posted on \n <\/p>\n\n Please provide your email address to receive an email when new articles are posted on .<\/p><\/div>\n<\/p><\/div>\n “ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nIn patients with ptosis, a large pupil may be indicative of third nerve palsy.<\/li>\nLevator function measurement can help determine the best treatment approach.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 Examining the pupil and performing motility checks are key for effectively managing patients with ptosis and catching underlying conditions, according to a speaker at Hawaiian Eye 2026.<\/p>\n\u201cWhen you think about the eyelid, and ptosis in general, the eyelid always runs with two friends: The pupil and the extraocular muscles,\u201d Andrew R. Harrison, MD,<\/b> <\/b>said. \u201cWhen you see a patient with an eyelid problem, a ptosis, you need to think about these two as well.\u201d<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\nIn patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\nAnother indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n \u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\nAccording to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\nIf the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\nIn patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
“ \n data-action=”subscribe”> \n Subscribe \n <\/button>\n <\/div>\n<\/p><\/div>\n We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.<\/strong> <\/p>\nBack to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nIn patients with ptosis, a large pupil may be indicative of third nerve palsy.<\/li>\nLevator function measurement can help determine the best treatment approach.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 Examining the pupil and performing motility checks are key for effectively managing patients with ptosis and catching underlying conditions, according to a speaker at Hawaiian Eye 2026.<\/p>\n\u201cWhen you think about the eyelid, and ptosis in general, the eyelid always runs with two friends: The pupil and the extraocular muscles,\u201d Andrew R. Harrison, MD,<\/b> <\/b>said. \u201cWhen you see a patient with an eyelid problem, a ptosis, you need to think about these two as well.\u201d<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\nIn patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\nAnother indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n \u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\nAccording to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\nIf the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\nIn patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
Back to Healio<\/button><\/p>\n<\/div>\n<\/div><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\nKey takeaways:<\/h2>\n\nIn patients with ptosis, a large pupil may be indicative of third nerve palsy.<\/li>\nLevator function measurement can help determine the best treatment approach.<\/li>\n<\/ul>\nWAIKOLOA, Hawaii \u2014 Examining the pupil and performing motility checks are key for effectively managing patients with ptosis and catching underlying conditions, according to a speaker at Hawaiian Eye 2026.<\/p>\n\u201cWhen you think about the eyelid, and ptosis in general, the eyelid always runs with two friends: The pupil and the extraocular muscles,\u201d Andrew R. Harrison, MD,<\/b> <\/b>said. \u201cWhen you see a patient with an eyelid problem, a ptosis, you need to think about these two as well.\u201d<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\nIn patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\nAnother indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n \u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\nAccording to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\nIf the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\nIn patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
WAIKOLOA, Hawaii \u2014 Examining the pupil and performing motility checks are key for effectively managing patients with ptosis and catching underlying conditions, according to a speaker at Hawaiian Eye 2026.<\/p>\n
\u201cWhen you think about the eyelid, and ptosis in general, the eyelid always runs with two friends: The pupil and the extraocular muscles,\u201d Andrew R. Harrison, MD,<\/b> <\/b>said. \u201cWhen you see a patient with an eyelid problem, a ptosis, you need to think about these two as well.\u201d<\/p>\n \n \n \n \n <\/source><\/source><\/source><\/source><\/source><\/picture> \n Image: Eamon N. Dreisbach | Healio<\/em> \n <\/figcaption> \n <\/figure>\nIn patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\nAnother indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n \u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\nAccording to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\nIf the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\nIn patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
In patients with ptosis, a large pupil may be a sign of third nerve palsy, Harrison said. These patients should immediately be given an MRI and an MRA to prevent an enlarging aneurysm. Additionally, a small pupil may be a sign of Horner\u2019s syndrome, according to Harrison.<\/p>\n
Another indicator of third nerve palsy among patients with ptosis is abnormal motility in patients with both asymmetric and symmetric pupils.<\/p>\n
\u201cThey could have myasthenia,\u201d Harrison said. \u201cDo the test where you have them hold their eyelid up and see if it comes down over time or do the ice pack test. They could have some other neuromuscular disorder like chronic progressive external ophthalmoplegia or muscular dystrophy. They could have thyroid eye disease. If they have asymmetric pupils and abnormal motility … you need to think about a third nerve palsy, because those patients are at risk.\u201d<\/p>\n
According to Harrison, levator function is the most important measurement to take for a patient with ptosis.<\/p>\n
\u201cBrace the brow, have the patient look up and down and measure that excursion,\u201d he said. \u201cIt’s really the excursion of the eyelid that you’re measuring \u2014 you’re not really measuring function, per se, but that’s what we call it \u2014 because that’s what we are going to use to determine which kind of surgery to do.\u201d<\/p>\n
If the patient has good levator function, which Harrison defined as excursion of 10 mm or greater, he recommends performing M\u00fcller\u2019s muscle-conjunctival resection (MMCR) or another form of levator surgery, along with tarsectomy for those with fair (5 mm to 10 mm of excursion) levator function. For patients with poor (< 4 mm of excursion) levator function, he recommended a frontalis sling. <\/p>\n
\u201cEither use an autogenous material like silicone or use their frontalis muscle to sling that eyelid up,\u201d he said.<\/p>\n
In patients with good levator function, the next step is to perform a phenylephrine test, according to Harrison.<\/p>\n
\u201cI think it works fine with 2.5%, and there is less risk of having a heart issue,\u201d he said. \u201cIf they have a good response, meaning the eyelid comes up to a normal height, you can do an MMCR procedure. If they don’t, you probably should do a levator resection.\u201d<\/p>\n
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