Introduction
Ptosis arises when the top eyelid droops over the eye. When the eyelid droops, it covers the pupil (the black spot at the middle of the eye that allows light to pass in).
If left untreated, ptosis may develop into astigmatism or amblyopia. The condition needs to be treated promptly, especially in children while they are still young as it may limit or even block vision completely.
Also Known As
- Blepharoptosis
- Droopy eyelid
Sub-Types
- Unilateral ptosis – Affects one eye
- Bilateral ptosis – Affects both eyes
- Congenital ptosis – When a child is born with this condition
- Involutional ptosis – When an adult gets this condition
Causes and Risk Factors
- Age – With age, the levator muscle (responsible for lifting the eyelid) begins to stretch and causes the eyelid to fall.
- Eye injury or disease – An eye injury can increase one’s risk of getting ptosis. The injury or illness may weaken the ligaments and muscles responsible for raising the eyelids.
Signs & Symptoms
- Droopy eyelid
- Watery or dry eyes
- Aching which causes the face to appear weary
- Tilting the head back to be able to see
- Lazy eye (amblyopia) – Poor vision in one eye that never developed properly during childhood
Diagnosis
The eye care professional is likely to conduct a physical exam and inquire about the patient’s medical history. After determining how often and how long the patient’s eyelids droop, he/she will conduct some tests to establish the cause.
The professional may also perform a slit lamp exam which incorporates the use of high-intensity light to examine the patient's eye.
A tensilon test can also be used. In this test, a drug known as tensilon will be injected into the patient’s veins. The patient would need to sit down and stand up several times to determine whether the drug improves muscle strength. This is necessary to check whether a disease called myasthenia gravis, a neuromuscular disorder that weakens the muscles, is causing ptosis.
Treatment
Treatment of ptosis is aimed at reducing the drooping and improving vision.
Medical Treatment
The eye doctor will probably recommend a ptosis crutch. This is a nonsurgical option which involves placing an attachment to the frames of the patient’s glasses. The crutch or attachment holds the eyelid in place to prevent drooping.
Crutches are either adjustable or reinforced. The adjustable crutches are used on one side of the glass frames whereas the reinforced crutches are used on both sides of the glass frames.
Surgical Treatment
The doctor may recommend surgery, especially in adults with ptosis. But, it may still be recommended for children to prevent the development of amblyopia.
During the procedure, the surgeon tightens the levator muscle to lift the eyelid to the right position.
A sling operation may be performed to elevate the eyelids by treating the forehead muscles.
Prognosis/Long-term outlook
Complications may arise after surgery. Some of the risks associated with surgical procedures include a scratched cornea, dry eye and hematoma (a collection of blood). The surgeon may also place the eyelid too low or too high.
The long-term outlook for eyelid drooping depends on the underlying cause. In most cases, it is a cosmetic issue. Since ptosis may be a sign of a dangerous disease, it is advisable to consult the doctor.
Follow up is necessary to address any complications that may arise during the postoperative period. After surgery, the surgeon may recommend a topical antibiotic ointment to be applied two times daily for seven days. Perioperative antibiotics or oral antibiotics may be administered for seven days. Pain is minimal but pain relief medication like Vicodin or Tylenol #3 may be prescribed.
Prevention/Follow Up
Ptosis has no prevention measures. Identifying the symptoms and going for a regular eye exam is the best way to keep the condition at bay. Since this condition can affect one’s vision, it should be treated early to prevent it from getting worse.
