Definition and Overview

Ptosis is the drooping of the upper eyelid. It occurs when the levator muscle, which holds the eyelid up, weakens.

Mild cases are often not a cause for concern. But if the eyelid droops far enough, it can block the pupil and cause partial blindness. It can also affect a person’s appearance.

Some children are born with ptosis. Others, on the other hand, develop the condition as they get older. The levator muscle can weaken as part of the ageing process. The condition is corrected with surgery. The prognosis for both children and adults is good in most cases.

Sometimes ptosis is a sign of a more serious medical condition. These include eye tumours, stroke, and nerve disorders. It can also occur due to trauma.

Depending on the cause, ptosis can affect one or both eyes.

Causes of Condition

Ptosis can be caused by a number of factors. These include:

  • Congenital anomalies - Congenital ptosis is caused by local developmental defects in muscle structure. In some patients who are born with the condition, their levator muscle is replaced by fat and fibrous tissue. Many babies with ptosis also have other eye-related problems. These include eye tumours and eye movement issues. Severe cases of congenital ptosis can lead to vision-related problems. These include amblyopia, or when one eye has better vision than the other. Patients are also at risk of astigmatism and strabismus. Astigmatism is a common eye problem that causes distorted or blurred vision. Strabismus, on the other hand, is when the eyes are not aligned. Congenital ptosis can be corrected early in life to prevent permanent loss of vision.

  • Ageing - Acquired ptosis is often caused by the natural ageing process. As a person gets older, the levator muscle becomes stretched. It can then weaken to the point that it can no longer hold the eyelid up.

  • Certain diseases and disorders - Ptosis is one of the symptoms of disorders that cause muscle weakness and nerve problems.

  • Damage to cranial nerves. A brain tumour, stroke, and brain aneurysms can cause such damage.

  • Eye surgeries - These include cataract surgery and LASIK. Ptosis can also be caused by wearing prosthetic eyes.

Key Symptoms

Symptoms of ptosis are:

  • A drooping or sagging eyelid.

  • Upper eyelid creases that do not line up evenly.

  • Vision problems. A sagging eyelid may partially block vision. Patients may need to tilt their head or lift up their chin to try to see better. In severe cases, the sagging eyelid can totally block vision.

Who to See and Types of Treatments Available

Ptosis of the eyelid is treated by eye specialists. Tests used to diagnose the condition are:

  • An eye exam - A person with any eye-related problem goes through a general eye exam. This test is used to check the overall health of the eyes. Patients are asked to read letters on a chart while standing 20 feet away. Their central and peripheral vision and eye movements are also checked. The doctor will also measure the distance between the upper and lower eyelids.

  • Review of medical history - The doctor would want to know if the patient has a history of certain diseases. They are also asked if they have close relatives with the same condition.

  • Neurological examination - This is used to determine if ptosis is caused by a brain aneurysm, brain tumour, or stroke. An MRI and a CT scan may be used.

  • Blood tests - These are used to determine if the condition is caused by muscle problems. Depending on the test results, a muscle biopsy may also be carried out.

Treatment

In many cases, ptosis is treated with surgery. The goal is to lift up the drooping eyelid. This improves vision and appearance. The surgery is safe for children and adults. It can also be performed in babies if their ptosis is severe. This helps reduce the risk of permanent vision damage.

Doctors can use local or general anaesthesia for this procedure. But many doctors prefer local anaesthesia. This allows them to check and adjust the position of the eyelids while the patient’s eyes are open. This helps ensure that the eyelid is not placed too low or too high.

The surgery can be performed to strengthen the levator muscle. It can also be used to elevate the eyelid using the forehead muscle. If needed, excess skin in the eyelid is also removed. Patients are advised to make a follow-up within one to two weeks after surgery. They are then evaluated for any signs of complications.

Surgery delivers excellent outcomes in most cases. But it has risks. These include haematoma (collection of blood), dry eye, and a scratched cornea.

References:

  • Harvard Health Publishing. Harvard Medical School. https://www.health.harvard.edu/diseases-and-conditions/drooping-eyelid-ptosis

  • Frueh BR, Musch DC, McDonald HM. Efficacy and efficiency of a small-incision, minimal dissection procedure versus a traditional approach for correcting aponeurotic ptosis. Ophthalmology. 2004;111:2158-63.

  • Lee MJ, Oh JY, Choung HK, Kim NJ, Sung MS, Khwarg SI. Frontalis sling operation using silicone rod compared with preserved fascia lata for congenital ptosis a three-year follow-up study. Ophthalmology. 2009;116:123-9.

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