Ptosis
Ptosis, also known as blepharoptosis, is when the upper eyelid droops over the eye. The eyelid may droop just a little, or so much that it covers the pupil. Ptosis can limit or even completely block normal vision. Ptosis can occur in one eye or both eyes at the same time.
If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.
Sign & Symptoms –
Signs and symptoms typically seen in this condition include –
• The eyelid(s) may appear to droop.
• Droopy eyelids can give the appearance of fatigue.
• The eyelid may not protect the eye as effectively, allowing it to dry out.
• Sagging upper eyelids can partially block the person’s field of view.
• Obstructed vision may cause a person to tilt their head back to speak.
• The areas around the eyes may become tired and achy.
• Eyebrows may be constantly lifted to see properly.
Causes & Types –
Ptosis occurs due to dysfunction of the muscles that raise the eyelid or their nerve supply (oculomotor nerve for levator palpebrae superioris and sympathetic nerves for superior tarsal muscle).
Congenital ptosis is present from birth and may have genetic causes. In this type of ptosis, the levator muscle doesn’t develop properly in the womb, so the child is born with compromised or little levator muscle function. It can affect one or both eyelids. Congenital ptosis can impair vision and cause amblyopia, sometimes known as lazy eye.
People can also acquire ptosis later in life. A common cause is accidental stretching or tearing of the levator aponeurosis, which is a tendon-like sheathe that allows the eyelid to move.
Five main types of acquired ptosis can develop throughout a lifetime.
• Aponeurotic ptosis, which is the most common type. In this condition, the levator muscle of the eyelid becomes overstretched, usually due to aging. Excessive eye rubbing or eyelid pulling due to eye irritation or long-term contact lens use can also cause the condition.
• Neurogenic ptosis occurs when there is a problem with the nerve pathway that controls movement of the eyelid muscles. Causes of neurogenic ptosis include myasthenia gravis, third nerve palsy, and Horner syndrome.
• Myogenic ptosis, the levator muscle is weakened due to a systemic disorder that causes muscle weakness. These conditions may include chronic progressive external ophthalmoplegia and types of muscular dystrophy.
• Mechanical ptosis, the eyelid is weighed down by excessive skin or a mass.
• Traumatic ptosis is caused by an injury to the eyelid—either due to an accident or other eye trauma. This injury compromises or weakens the levator muscle.
The eyes and eyelids are delicate, and there are many other potential causes of acquired ptosis, including:
• Eyelid tumors, cysts, or swelling
• Horner’s syndrome
• Muscular problems
• Nerve damage in the eye muscles
• Neurological conditions
• Eye trauma
• Botox injections
• Use of high doses of opioid drugs such as morphine, oxycodone, heroin, or hydrocodone
Risk Factors –
Potential risk factors for ptosis include –
• Age
• Contact lenses
• Excessive eye rubbing
• Eye surgery
• Horner’s syndrome
• Myasthenia gravis
• Diabetes.
• History of stroke.
• Cancer.
• Neurological disorder
Complications –
• An uncorrected drooping eyelid can lead to amblyopia (loss of vision in that eye)
• An abnormal eyelid position can have negative psychological effects like poor self-esteem and alienation especially in teenagers and young children.
• You may have headaches due to tension in your forehead muscles.
• Decreased vision can affect your daily activities especially driving, using a flight of stairs etc.
Diagnosis –
An eye doctor will diagnose ptosis by examining your eyelids closely. They will measure the height of your eyelids and the strength of the eyelid muscles.
They may also perform a computerized visual field test to see if your vision is normal. In a visual field test, you are asked to look at a series of flashing lights in a machine, without moving your eyes. When you see a light, you push a button.
Treatment –
Treatment usually depends on how well the eyelid muscles are functioning. If the ptosis does not affect vision and the patient does not mind the appearance, the doctor might recommend no treatment at all.
Often, doctors won’t treat children with ptosis. They will check their eyes regularly. And they’ll probably treat amblyopia with drops, patches, or glasses. The doctor will also watch the eye to see if your child needs surgery as they get older. For adults, treatment usually does mean surgery.
Ptosis surgery is performed under local anesthesia with sedation (the patient is awake but does not feel the procedure). The types of surgery to repair the droopy lid include the following –
• The surgeon makes an opening in the skin of the upper eyelid. This allows the surgeon to find the small muscle that raises the eyelid. The surgeon places stitches to tighten this muscle and raise the eyelid. The incision in the skin of the eyelid is then closed with more stitches.
• The surgeon can perform the entire surgery from underneath the eyelid. In this case, the eyelid is flipped and the muscle is tightened from underneath. No skin incision is required for this approach.
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