Ptosis is Drooping or falling of the upper or lower eyelid. The drooping may be worse after being awake longer, when the individual’s muscles are tired. This condition is sometimes called “lazy eye”, but that term normally refers to amblyopia. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.
- Neurogenic ptosis which includes oculomotor nerve palsy, Horner’s Syndrome, Marcus Gunn jaw winking syndrome, Third cranial nerve misdirection.
- Myogenic ptosis which includes myasthenia gravis, myotonic dystrophy, ocular myopathy, simple congenital ptosis, blepharophimosis syndrome
- Aponeurotic ptosis which may be involutional or post-operative.
- Mechanical ptosis which occurs due to edema or tumors of the upper lid
- Neurotoxic ptosis which is a classic symptom of envenomation by elapids such as cobras, or kraits. Bilateral ptosis is usually accompanied by diplopia, dysphagia and/or progressive muscular paralysis. Regardless, neurotoxic ptosis is a precursor to respiratory failure and eventual suffocation caused by complete paralysis of the thoracic diaphragm. It is therefore a medical emergency and immediate treatment is required.
Pseudo ptosis due to:
- Lack of lid support: empty socket or atrophic globe.
- Higher lid position on the other side: as in lid retraction
- Drooping of one or both eyelids
- Increased tearing
- Interference with vision (if the drooping is severe)
If a disease is found, it will be treated. Most cases of drooping eyelids are due to aging and there is no disease involved.
Aponeurotic and congenital ptosis may require surgical correction if severe enough to interfere with vision or if cosmetics is a concern. Treatment depends on the type of ptosis and is usually performed by an ophthalmic plastic and reconstructive surgeon, specializing in diseases and problems of the eyelid.
Surgical procedures include:
- Levator resection
- Müller muscle resection
- Frontalis sling operation
Non-surgical modalities like the use of “crutch” glasses or special Scleral contact lenses to support the eyelid may also be used.
Atlas of Ptosis:
Blepharoplasty Ptosis Surgery
Muller’s muscle resection
Levator Muscle Resection
Ptosis Correction Frontalis Sling
Myasthenia gravis and Ptosis
Ptosis Causes,Diagnosis and Treatment Notes