We report a group of patients with involutional blepharoptosis most pronounced in downgaze. Retrospective analysis was performed on all patients who underwent involutional blepharoptosis repair in a 30-month period. Physical examination and visual field testing confirmed the increased blepharoptosis in downgaze. The average increase in visual field obstruction is 12.5 degrees and the drop in the upper eyelid relative to the visual axis is 1.9 mm. We conclude that the increased visual field obstruction in downgaze in this subset of patients is significant and deserves clinical evaluation.