Ptosis or Drooping Eyelid: Symptoms, causes, diagnosis and treatment (1)

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Ptosis or Drooping Eyelid
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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.

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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.

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What are the causes of ptosis or drooping eyelid?
Continue

• 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-term diabetes. 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.

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What are the causes of ptosis or drooping eyelid?
Continue

• 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.

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Symptoms

• 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 cause tension
  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.

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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
  thorough examination of your eye. If your eye
  specialist finds anything abnormal,
  special diagnostic tests are 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.

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Treatments

• If age-related ptosis blocks your vision or
  seriously affects your appearance, a plastic
  surgeon usually 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,
  your ophthalmologistprobably will recommend
  prompt corrective surgery because early treatment
  reduces the risk of permanent vision 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 surgery is 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.

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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.

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