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Ptosis

Ptosis

What is ptosis (drooping of upper eyelid)?

  • Ptosis (pronounced TOE-sis) is the medical term for drooping eyelids. A person with ptosis is not able to lift one or both upper eyelids to uncover the eye completely.
  • Many people want to correct ptosis because it damages their appearance. In most cases, the sagging upper eyelid results in a loss of the superior (upper) field of vision.
  • Ptosis may be present at birth and, if left untreated, can permanently damage vision by forcing the unaffected eye to do all the work, while letting the affected eye not develop as regards vision and leading to development of Amblyopia.

What are the causes of ptosis?

There are various causes of ptosis however here we will be explaining the two most common causes of ptosis.

Acquired or Levator Dehiscence Ptosis:
This is the most common type of upper eyelid ptosis. The tendon of the Levator muscle may loosen or detach, causing ptosis. The Levator muscle is that muscle of the eye which is responsible for elevating the upper eyelid of the eye. This process is similar to a knee ligament sprain or tear. Levator dehiscence occurs primarily in people greater than thirty years of age and the incidence increases with age. It is not uncommon for one to develop a droopy upper eyelid following cataract surgery. The cataract surgery may be the “last straw” that causes a weak tendon to finally give way.

Congenital Ptosis:
Congenital ptosis is the common form of eyelid ptosis present since childbirth. It may involve one or both upper eyelids and vary in severity from mild to severe. This form of eyelid ptosis is often the result of lack of development of the levator muscle. Treatment is primarily surgical where the affected eyelid muscles are shortened / resected for eyelid elevation. The surgery may also use other methods to repair the ptosis, such as a technique called fascia suspension.

What are the signs and symptoms of ptosis?

The causes of ptosis are quite diverse. The symptoms are dependent on the underlying problem and may include:

  • Drooping lid (may affect one or both eyes)
  • Irritation
  • Difficulty closing the eye completely
  • Eye fatigue from straining to keep eye(s) open
  • Children may tilt head backward in order to lift the lid
  • Crossed or misaligned eye
  • Double vision

What problems can occur as a result of childhood ptosis?

Childhood ptosis presents a very serious problem. If the ptosis is significant enough to occlude the eye then the vision of the child from that eye is blocked . normally vision in an eye develops in the first 7-8 yrs of life. Blockage of vision in this age group may result in permanent loss of vision in that eye.

Detection and diagnosis

When examining a patient with a droopy lid, one of the first concerns is to determine the underlying cause. The doctor will measure the height of the eyelid, strength of the eyelid muscles, and evaluate eye movements and alignment. Children may require additional vision testing for amblyopia

Treatment

Ptosis does not usually improve with time, and nearly always requires corrective surgery by an ophthalmologist specializing in plastic and reconstructive surgery. In most cases, surgery is performed to strengthen or tighten the levator muscle and lift the eyelid. If the levator muscle is especially weak, the lid and eyebrow may be lifted. Ptosis is usually performed under general anesthesia.