Encyclopedia - Ptosis

What makes ptosis occur?
What are the signs of ptosis?
How is ptosis treated?

Ptosis is the medical term used to describe drooping of the upper eyelid, partially or completely covering the eye. It may be congenital or caused by paralysis or weakness of the nerves that control eyelid movement, or it can be caused by excessive weight of the upper lids. In 75 percent of the cases, only one eye is affected. However, in age-related ptosis, the condition can affect both eyelids. Poor blinking reflexes accompany ptosis, and the extent of the droop may vary throughout the day.

What makes ptosis occur?

Age is the most common cause of ptosis. Muscles stretch and thin out causing a loss of muscle tone that results in the inability to hold the upper lid in the proper position. Ptosis can also be caused by a malfunction of the nerves that control the eyelid muscles. It may also develop because of complications of diabetes, muscular dystrophy, kidney disease, a brain tumor, a head or eye injury, or allergies. Ptosis can be the result of an eyelid tumor, which restricts the action of the levator, the muscle that raises the upper eyelid. The condition sometimes also develops following cataract or other eye surgery.

The most common cause of congenital ptosis (occurring at birth) is improper development of the levator muscle, the major muscle responsible for lifting the upper eyelid. Sometimes ptosis in children is related to astigmatism, a condition in which the cornea is uneven in curvature. Children with congenital ptosis may also have amblyopia (lazy eye) and/or strabismus (cross-eyes).

What are the signs of ptosis?

Drooping eyelids are the most obvious sign of ptosis. Eye infections and eye irritation are prominent because of the eye’s inability to blink properly, causing continuous contact between the eyelid and surface. Symptoms may also include headaches and eyestrain, usually brought on by raising the entire brow with the forehead and scalp muscles. Children with ptosis may tilt their heads back, raise their eyebrows, or lift their eyelids with a finger in order to be able to see. If ptosis in children is severe, it can lead to amblyopia, or lazy eye, and a permanent loss of vision.

How is ptosis treated?

To treat ptosis in children and adults, an ophthalmic plastic and reconstructive surgeon performs surgery. In children, this is usually done between the ages of 3 and 5, but it may be performed earlier if the condition interferes with proper vision. The surgery tightens the levator muscle so the lid is raised to match the lid on the other side. If the levator is extremely weak, the eyelid may be attached to the brow muscles, which enables the forehead to elevate the lid. The procedure is often done under local anesthetic on a same-day, outpatient basis. After surgery, the upper eyelids will be swollen and will feel tight, and there may be some minor discoloration and bleeding. After healing, scarring is virtually invisible.

In minor cases of ptosis, the ophthalmologist will sometimes suggest keeping the lid raised with a support that is part of eyeglasses.