Eyelid ptosis

What is an eyelid ptosis?

The eyelid may fall slightly or may cover the pupil. One or both eyelids may be affected. Ptosis that is present at birth is called congenital ptosis. If the ptosisin one eyelid is severe, the child’s vision may not develop properly. This can lead to amblyopia (it is also called lazy eye, a condition in which the brain uses images only from the “good” eye). Ptosis that develops later is called an adult or acquired ptosis.

Congenital ptosis occurs when the levator muscle, the muscle that lifts the eyelid upwards, is poorly developed.

The acquired (adult) ptosis occurs when there is an abnormality in:

  • the levator muscle
  • the levator muscle tendon
  • the nerve supply to the levator muscle

These conditions can be caused by:

  • aging
  • muscle or nerve disorders
  • tumors or aneurysms
  • Injury
  • diseases such as diabetes that affect the nerves and muscles

If ptosis occurs suddenly, the cause may be a brain aneurysm. In this case it is a medical emergency.

The drooping eyelid is the main symptom of ptosis. People with ptosis may tilt their heads backwards or raise their eyebrows to lift the eyelid. Adults may notice a loss of vision, especially in the upper part of their visual field. After many years of keeping their head in abnormal positions, they may have deformities of the head or neck.

Congenital ptosis will not improve without surgery. However, timely correction will help the child develop normal vision in both eyes.
Some acquired ptosis caused by nerve problems will improve without treatment. Some drop due to muscle disease improves when the disease is treated with the appropriate medications. Often the effects of the fall last until the appropriate surgery is performed.

The ophthalmic surgeon will examine you thoroughly. He can order blood tests and brain imaging to determine the cause and the best treatment plan.

Treatment for congenital ptosis is usually surgery to attach the levator muscle to the muscles of the brow. All children who have a fall, whether they have undergone surgery or not, should have regular eye examinations to check for problems that may occur.

Treatment for acquired ptosis depends on its cause. If ptosis is the result of muscle or nerve disease, the doctor will first treat the disease. If the cause is a tumor, it can sometimes be removed. If the ptosis is simply due to the normal aging process, the oculoplastic surgeon may recommend surgery to reduce the levator muscle or remove the extra skin that weighs down the eyelid.

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