Ptosis

Definition

Ptosis, also known as blepharoptosis, is the drooping or falling of the upper eyelid. It can affect one eye (unilateral) or both eyes (bilateral) and can range from mild to severe enough to cover the pupil, affecting vision.

Causes of Ptosis

1. Congenital Ptosis

   • Present at birth due to poor development of the levator muscle (which lifts the eyelid).

2. Acquired Ptosis

   • Neurogenic: Due to nerve problems (e.g., third cranial nerve palsy, Horner's syndrome).

   • Myogenic: Muscle diseases such as myasthenia gravis or muscular dystrophy.

   • Aponeurotic: Age-related weakening or detachment of the levator aponeurosis (most common in older adults).

   • Mechanical: Caused by eyelid tumors, swelling, or scarring.

   • Traumatic: Injury to eyelid muscles or nerves.

Symptoms

• Drooping eyelid(s)

• Difficulty keeping the eye open

• Eye fatigue, especially when reading or concentrating

• Possible double vision (if related to nerve/muscle problems)

• Sometimes compensatory forehead muscle overuse to lift the eyelid

Diagnosis

• Physical eye examination

• Measurement of eyelid droop (margin-reflex distance)

• Testing eyelid muscle function

• Neurological examination if nerve involvement is suspected

• Imaging (MRI or CT) in some cases

• Blood tests for myasthenia gravis or other systemic causes

Types of Ptosis

1. Congenital Ptosis

2. Acquired Ptosis

   • Neurogenic

   • Myogenic

   • Aponeurotic

   • Mechanical

   • Traumatic

Treatment

Non-Surgical

• Observation if mild and no vision problems

• Treatment of underlying cause (e.g., myasthenia gravis medications)

• Ptosis crutches: Eyeglass attachments that lift the eyelid

Surgical

• Levator resection or advancement (strengthen levator muscle)

• Frontalis sling operation (uses forehead muscle to lift eyelid, especially in severe cases or poor levator function)

• Surgery depends on the severity, cause, and patient’s age

Prognosis

• Depends on cause

• Congenital ptosis often requires surgery for better vision and cosmetic reasons

• Acquired ptosis can be managed well if underlying disease is treated