Ptosis of eyelid | symptoms| cause| Risk factors| Diagnosis| Treatment|

Ptosis of eyelid

The abnormal drooping of the upper eyelid is called Ptosis which is due to trauma, age, or various medical disorders

Normally, the upper lid covers about the upper one-sixth of the cornea,i.e., about 2mm. So, that ptosis covers more than 2 mm.

In the medical team, this condition is known as unilateral ptosis when it affects only one eye and bilateral ptosis when it affects both eyes.

It is common to come and go or it might be permanent. If it is due to birth, then it is known as congenital ptosis, or which can develop later in life is known as acquired ptosis.

Talking about the severity of the condition droopy upper eyelid can block or can reduce vision.

Etiology

1. Congenital
2. Acquired

• Neurogenic ptosis
• Acquired myogenic ptosis
• Aponeurotic ptosis
• Mechanical ptosis

Cause

1. In newborn babies, it is caused due to birth.
2. It can also be found in adults due to damaged nerves that control eyelid muscles.
3. It may be due to injury or disease that weakens the muscles and ligaments that raise eyelids.
4. It might be due to age, the skin and muscle around the eyes get Weaker.
5. It may be due to surgery like LASIK or cataracts which can stretch eyelids.
6. It can also be due to a tumor or any other medical condition.

Symptoms

1. Droopy eyelid of one or both upper eyelid sag.
2. Painless but can affect vision.
3. You may also feel dry or watery eyes.
4. You may feel aching and notice your face looks tired.
5. Difficulty to look, you have to tip your head back and lift your chin to see better.
6. It may also develop amblyopia or lazy eye 

How common is ptosis?

As it is not so common. But the common form of ptosis that is present from birth is due to poor development of levator palpebrae superior muscles.

Risk factors

Medical conditions

If you have medical disorders like tumors and it may be an injury in the nerve or temporary stye. LASIK or cataract surgery can also increase your risk factor.

Serious conditions

In some cases, ptosis is caused by serious conditions, like brain tumor, stroke, or cancer of nerves or muscles.

Nerves or muscles of the eye are affected by neurological disorders, like myasthenia gravis.

Diagnosis

Your doctor will perform a physical examination and ask you about your medical history.

Your doctor will perform a slit lamp examination to take a close look at your eye with the help of high-intensity light. Your doctor will dilate your eye for this examination. So, that you may feel slight eye discomfort.

Another test that can be used to diagnose droopy eyelids is called the Tensilon test.

Your doctor will inject you a drug called Tensilon, known as edrophonium into your veins. And you may be asked to cross and uncross your legs or stand up and sit down several times.

And your doctor will monitor you to see if Tensilon improves or not. This will help them to determine the condition.

Treatment

Treatment of droopy eyelids depends on their causes and severity.

If you have ptosis due to birth your doctor will explain that it is not necessary to do anything because it is not harmful to your health. Or if you want to reduce the drooping you can do Surgery.

If your eyelids have blocked your vision, your doctor will recommend medical treatment. Or if it is serious your doctor will recommend surgery.

Congenital ptosis

 Characteristic of congenital ptosis

• The dropping of one or both upper lids more often since birth of variable severity (mild, moderate, or severe).
• The lid crease is either diminished or absent.
• Lid long on downgaze (i.e., the ptotic lid is higher than the normal) due to tethering effect of abnormal LPS muscle. This is in contrast to acquired ptosis in which the ptosis lid is lower than the normal in downgaze also.
• The LPS function may be poor, fair, or good depending upon the degree of weakness.

Associated features. Based on the absence or presence

1. The Simple congenital ptosis (it is not associated with any other anomaly)
2. The Congenital ptosis with associated weakness of superior rectus muscle.
3. Blepharophimosis syndrome, which comprises congenital ptosis, blepharophimosis- underdeveloped eyelid, telecanthus- increases the distance between the inner corners of the eyelid and epicanthus inversus.
4. Congenital syn-kinetic ptosis -In this condition, there occurs retraction of the ptosis lid with jaw movements, i.e., with stimulation of the ipsilateral pterygoid muscle.

Acquired ptosis

Depending upon the cause it can be 

• Neurogenic
• Myogenic
• Aponeurotic or
• Mechanical.

1. Neurogenic ptosis. It is caused by an innervational defect such as :

• Third nerve palsy 
• Horner's syndrome
• Ophthalmoplegic migraine, and  

Multiple sclerosis

2. Acquired myogenic ptosis. It occurs due to acquired.

• The Disorders of the LPS muscle or of the myoneural junction. It may be seen in patients with myasthenia
• Gravis,dystrophia myotonica ocular myopathy, oculopharyngeal muscular dystrophy and following
• Trauma to the LPS, muscle thyrotoxicosis, and 
• Lambert eaton myasthenia syndrome.

3. Aponeurotic ptosis. It develops due to defects of 

• levator aponeurosis in the presence of a normal
• Functioning muscle. It includes:
• Postoperative ptosis (which is rarely observed after cataract and retinal detachment surgery),
• Traumatic dehiscence or disinsertion of the aponeurosis
• Ptosis due to aponeurotic weakness associated with blepharochalasis

4. Mechanical ptosis. It may result due to excessive

• Weight on the upper lid as seen in patients with lid.
• Tumours, multiple chalazia and lid oedema. It may occur due to scarring (cicatrical ptosis) as seen in patients with ocular pemphigoid and trachoma.

Written by Barsha Panth