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# Levator palpebrae

The levator palpebrae is a thin muscle in the eye socket that ends in the upper eyelid; it lifts the lid, which droops when the muscle or its nerve fails.

Official name: Levator palpebrae superioris

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## What it is

A thin muscle above the superior rectus, ending in the upper eyelid.

## What it does

Lifts the upper eyelid; weak in a third-nerve palsy (droopy lid).

## Key points

- The levator (oculomotor nerve (III)) does most of the lifting; the superior tarsal (Müller) muscle on its underside adds about 1–2 mm under sympathetic control
- Complete ptosis suggests an oculomotor (III) palsy; mild ptosis with a small pupil suggests Horner syndrome, which takes out only the Müller muscle
- Behind the orbital rim the muscle changes direction from horizontal to vertical at the superior transverse (Whitnall) ligament, then fans out as the aponeurosis into the tarsus and [skin](https://durgical.com/en/anatomy/skin/)
- Aponeurotic ptosis in older adults: the aponeurosis thins or detaches from the tarsus; levator function stays good and the lid crease rises

## Key facts

**Origin**
Lesser wing of the sphenoid above the [optic canal](https://durgical.com/en/anatomy/optic-canal/)

**Insertion**
Skin and tarsal plate of the upper eyelid

**Action**
Elevates the upper eyelid

**Nerve**
Oculomotor nerve (III), superior division; superior tarsal (Müller) part: sympathetic

**Blood supply**
[Ophthalmic artery](https://durgical.com/en/anatomy/ophthalmic-artery/) (muscular branches)

## Relations

**Course**
From the lesser wing of the sphenoid it runs forward under the orbital roof, above the [superior rectus](https://durgical.com/en/anatomy/superior-rectus-muscle/), to Whitnall ligament; the aponeurosis then descends in the upper eyelid, its horns anchored to the medial and lateral orbital walls

**Above**
Orbital roof; the frontal nerve and supraorbital vessels run forward on its upper surface

**Below**
Superior rectus, which shares its fascial sheath and the superior division of the [oculomotor nerve](https://durgical.com/en/anatomy/oculomotor-nerve/), so the lid rises with upgaze

**In front**
Orbital septum, with the preaponeurotic fat pad between septum and aponeurosis: the surgeon's landmark in ptosis repair

**Deep**
Superior tarsal (Müller) muscle and the conjunctiva of the upper [fornix](https://durgical.com/en/anatomy/fornix/)

**Lateral**
Lateral horn of the aponeurosis, which divides the [lacrimal gland](https://durgical.com/en/anatomy/lacrimal-gland/) into orbital and palpebral lobes

## How to find it

Its action is judged by the movement of the upper lid. The examiner holds the brow still with a thumb (to cancel [frontalis](https://durgical.com/en/anatomy/occipitofrontalis-muscle/)) and watches the lid margin from full downgaze to full upgaze. The lid crease, where aponeurotic fibres reach the skin, lies a few millimetres above the margin.

## Examination

- Levator function: lid excursion from downgaze to upgaze with the brow fixed, normally about 15 mm; poor function (about 4 mm or less) suggests a congenital (myogenic) or neurogenic cause
- Margin reflex distance 1 (MRD1): from the corneal light reflex to the upper lid margin, normally about 4–5 mm; it grades how severe the ptosis is
- Fatigue and ice-pack tests: ptosis that worsens with sustained upgaze and improves after the lid is cooled suggests myasthenia gravis
- Pupils in every ptosis: a large pupil on the side of the ptosis points to a compressive oculomotor (III) palsy, a small one to Horner syndrome

## On imaging

On coronal CT or MRI it lies just above the superior rectus under the orbital roof and is hard to separate from it; sagittal MRI follows it forward into the aponeurosis of the upper lid. Ptosis itself is judged clinically; imaging seeks the cause: MRI with MR or CT angiography in a third nerve palsy with a dilated pupil (aneurysm), or a search along the sympathetic chain in Horner syndrome.

## Clinical notes

- A pupil-involving oculomotor (III) palsy with ptosis and an eye turned down and out can signal a [posterior communicating artery](https://durgical.com/en/anatomy/posterior-communicating-artery/) aneurysm, an emergency; pupil-sparing palsies are often microvascular (diabetes, hypertension)
- Congenital ptosis that covers the pupil can cause amblyopia and is corrected early, often with a frontalis sling when levator function is poor
- Aponeurotic ptosis is also seen after eye surgery and with long-term contact [lens](https://durgical.com/en/anatomy/lens/) wear; repair reattaches or advances the aponeurosis on the tarsus
- Aberrant regeneration after an oculomotor (III) palsy: fibres meant for other muscles reach the levator, so the lid rises when the eye looks down or inward
- Thyroid eye disease causes lid retraction and lid lag on downgaze, from overaction of the superior tarsal muscle and scarring of the levator

## Development

It splits off from the superior rectus primordium during development, which is why congenital ptosis may come with weak elevation of the same eye.

## Related conditions

- [Myasthenia gravis](https://durgical.com/en/conditions/myasthenia-gravis/)
- [Oculomotor (third) nerve palsy](https://durgical.com/en/conditions/oculomotor-nerve-palsy/)

## Test yourself

Think of the answer, then tap the question to see it.

## Which muscles lift the upper eyelid, and what is the nerve supply of each?

The levator palpebrae superioris (oculomotor nerve III) does most; the superior tarsal (Müller) muscle adds about 1–2 mm under sympathetic control.

## How does ptosis differ between an oculomotor (III) palsy and Horner syndrome?

Oculomotor palsy: complete ptosis (levator); Horner syndrome: mild ptosis with a small pupil, as only the Müller muscle is lost.

## How is levator function measured, and what is normal?

Lid excursion from downgaze to upgaze with the brow held still; normally about 15 mm.

## What are the features of aponeurotic ptosis in older adults?

The levator aponeurosis thins or detaches from the tarsus; levator function stays good and the lid crease rises.

## What can a pupil-involving oculomotor (III) palsy with ptosis signal?

A posterior communicating artery aneurysm, an emergency; pupil-sparing palsies are often microvascular.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
levator palpebrae superioris TA2 2052

**Official Spanish (DeCS)**
Músculo elevador del párpado superior DeCS D009801

**English (TA2)**
Levator palpebrae superioris

**Also called**
levator palpebrae superioris muscle · lamina superficialis levatoris palpebrae superioris

## Related

- [Eyelids](https://durgical.com/en/anatomy/superior-tarsus/)
- [Oculomotor nerve (III)](https://durgical.com/en/anatomy/oculomotor-nerve/)

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=9987&filter=ths_termall&q=Oculomotor%20Muscles); [Anatomy, Head and Neck: Levator Palpebrae Superioris Muscle](https://www.ncbi.nlm.nih.gov/books/NBK536921/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/levator-palpebrae-superioris/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/levator-palpebrae-superioris/