Ptosis or Drooping Eyelid

Introduction of Ptosis or Drooping Eyelid

A drooping eyelid is also called ptosis or blepharoptosis. In this condition, the

border of the upper eyelid falls to a lower position than normal. In severe cases,
the drooping eyelid can cover all or part of the pupil and interfere with vision.

Ptosis can affect one or both eyes. It may be present at birth congenital ptosis,or
it may develop gradually over decades. Sometimes ptosis is an isolated problem
that changes a person's appearance without affecting vision or health. In other
cases, however, it can be a warning sign that a more serious condition is affecting
the muscles, nerves, brain or eye socket. Ptosis that develops over a period of
days or hours is more likely to signify a serious medical problem.

What are the causes of ptosis or drooping eyelid?

Congenital ptosis:In this condition, an infant is born with ptosis because of a
developmental problem involving the muscle that raises the upper eyelid (levator
muscle). In approximately 7 out of 10 cases, the condition affects only one eye. If
the drooping eyelid obscures part of the baby's visual fields, surgery must be done
to correct the problem early in life to prevent permanent loss of vision.
Aponeurotic ptosis:Aging is the most common cause of ptosis that is not present
at birth. In senile ptosis, the long-term effects of gravity and aging cause stretching
of a wide, tendon-like tissue that helps the levator muscle lift the eyelid. Although
both eyes usually are affected, drooping may be worse in one eye.
Myasthenia gravis:Ptosis can be one of the first symptoms of
myasthenia gravis, a rare disorder that affects the ways muscles respond to
nerves. Myasthenia gravis can cause progressive muscle weakness, not only in the
eyelids but also in the facial muscles, arms, legs and other parts of the body.
Muscle diseases:Ptosis can be a symptom of an inherited muscle disease called
oculopharyngeal muscular dystrophy that affects eye motion and can cause
difficulty swallowing. In younger adults, ptosis can be caused by a group of muscle
illnesses called progressive external ophthalmoplegia, which cause ptosis in both
eyes, problems with eye movement, and sometimes other muscle symptoms that
involve the throat or heart muscle.

Nerve problems:Because the eye muscles are controlled by nerves that come
from the brain, conditions that injure the brain or its cranial nerves sometimes can
cause ptosis. These conditions include stroke,brain tumour, a brain aneurysm (a
grapelike swelling on a blood vessel inside the brain), and nerve damage related
to long-termdiabetes. Another cause of ptosis is Horner's syndrome, which also
can cause an abnormally small pupil and loss of the ability to sweat - on half the
face. One particularly dangerous cause of Horner's syndrome is a cancerous
tumour located at the top portion of the lungs.
Local eye problems:In some cases, an eyelid droops because of an infection or
tumour of the eyelid, a tumour inside the eye socket, or a blow to the eye.

Symptom of Ptosis or Drooping Eyelid

Ophthalmologists assess the severity of eyelid droop by taking precise
measurements of the eyelid and eye opening. You can screen for the problem
yourself by looking straight ahead in a mirror. As you look at your eye, a sizable
part of your iris (the eye's coloured circle) should be visible above your pupil, and
no part of the pupil itself should ever be covered by the eyelid.
If you have ptosis, the drooping eyelid narrows your eye's opening, which makes
your affected eye appear smaller than normal. You also may lose the crease (fold of
skin) that normally lies between your upper eyelid and eyebrow. If ptosis covers
your pupil and limits your vision, you may try to compensate unconsciously by
raising your eyebrows. This can causetension headachesand give your eyes an
odd, surprised appearance. You also may tilt your chin up and look down your nose
as a way of seeing out from under your eyelid's lower margin.
If you have simple, uncomplicated ptosis, you won't have any other symptoms. If
your ptosis is caused by a more serious medical problem, however, you may have
additional symptoms that are related to the underlying illness.

How ptosis or drooping eyelid is diagnosed?

If you notice that both of your upper eyelids have become progressively droopy
with age, then you probably have simple age-related ptosis. Some old
photographs usually can confirm the diagnosis because they prove that your
drooping eyelids have worsened gradually over the years.
In other cases of ptosis, an ophthalmologist must diagnose the problem. The
ophthalmologist will begin by reviewing all of your symptoms, not just your
eyelid complaints. This review includes any symptoms of double vision, muscle
fatigue or weakness, difficulty speaking or swallowing, headache, or tingling or
numbness anywhere in your body. Your doctor also will review your past medical
history and ask about any family history of ptosis or inherited muscle diseases.
Then, your ophthalmologist will do a physical examination, a neurological
examination, and a thoroughexamination of your eye. If your eye specialist
finds anything abnormal, specialdiagnostic testsare necessary. For example,
you may need a computed tomography (CT) scan or magnetic resonance
imaging (MRI) scan if you have signs of a neurological problem or if your eye
examination reveals evidence of a mass or swelling inside your eye socket.

Treatment of Ptosis or Drooping Eyelid

If age-related ptosis blocks your vision or seriously affects your appearance, a
plastic surgeonusually can correct the problem by surgically raising your eyelid.
In most adult patients, this is an outpatient procedure that is done under local
anaesthesia. Local anaesthesia is preferred over general anaesthesia because it
allows the surgeon to adjust the position of your eyelids while your eyes are open.
If your baby is born with severe congenital ptosis, yourophthalmologistprobably
will recommend prompt corrective surgery because early treatment reduces the
risk of permanentvision damage. If your child has milder ptosis without impaired
vision, however, the ophthalmologist may suggest waiting until the child is 3 to 5
years old to correct the drooping eyelid. During childhood,eyelid surgeryis
performed under general anaesthesia.
If you have ptosis that is caused by a muscle disease, neurological problem or
local eye problem, your ophthalmologist will treat the illness. In some cases, this
treatment either improves the drooping eyelid or keeps it from getting worse.
Ptosis or drooping eyelid surgery outlook
In most cases, the prognosis is good. Surgery usually can correct the drooping
eyelid in children with congenital ptosis and adults with age-related ptosis. In
some cases, corrective surgery causes the eyes to remain open slightly during
sleep, so a night-time lubricant is applied to the eyes to prevent drying.