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Ptosis commonly refers to a drooping upper eyelid. This droop may be only slight or it may be enough to cover part, or all the eye. It can affect one or both upper eyelids.
What causes ptosis?
1. In adults
The commonest cause is as a result of ageing. The main tendon within the eyelid, which helps lift up the eyelid when looking up, may become stretched resulting in ptosis.
Less common causes include:
Following an injury or previous surgery to the eye.
From long term contact lens wear.
As a complication of another disease involving the eyelid muscle or its nerve supply, e.g. stroke, myasthenia gravis or diabetes.
2. In children
Ptosis can be present at birth (congenital ptosis) as a result of abnormal development of the muscle involved in lifting the eyelid. Ptosis in children may also be caused by eye movement abnormalities or diseases affecting the muscle or nerve of the eyelid. Uncommonly, the ptosis may also be associated with abnormal movements of the eyelid itself such as winking whilst chewing, known as “Jaw Winking”.
What are the symptoms & signs of ptosis?
-Patients may complain about the cosmetic appearance of a drooping lid.
-The droopy eyelid may obstruct the upper field of vision.
-Patients may tip their head back or raise their eyebrows in an effort to raise their lids, occasionally leading to headache or neck strain.
-A severe or moderate congenital ptosis, especially if it blocks the line of sight, may hinder normal development of vision, causing a lazy eye (also called amblyopia), which if left untreated, may lead to permanently poorer vision in the affected eye.
How is ptosis treated?
Treatment may include the following:
-Investigations e.g. blood tests. To determine the cause of the ptosis.
Surgery to lift the position of the eyelid.
The operation is usually done as a day case procedure under local anaesthetic for adults. Surgery performed in young children is usually done under general anaesthesia.
The type of surgery performed is dependent on the individual characteristics of the patient’s ptosis, however the vast majority of patients do very well with minimally invasive surgery with no visible scarring.
blepharoplasty (removal of hooded excess skin of the upper lids) so that a better cosmetic result can be obtained. Here the excess tissues of the lid are removed at the same time as the ptosis operation and on average extends the operation by 30 minutes. The are no additional scars or incisions since both operations are performed via the same incision, using the same anaesthetic.
Age related ptosis of both upper lids.
Preoperative (Left) and 4 weeks postoperative (right) ptosis correction to both upper lids. Note the very fast recovery and minimal swelling
Right upper lid ptosis due to contact lens wear
.
Preoperative (top left). Postoperative pictures (top right taken immediately following surgery, bottom left and bottom right taken 6 days following surgery). Note the rapid recovery and incision scar designed to mimic the natural skin crease of the eyelid.
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