Ptosis is an abnormally low position (drooping) of the upper eyelid.
The drooping may be worse after being awake longer, when the
individual's muscles are tired. If severe enough and left untreated,
the drooping eyelid can cause other conditions, like 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.
Ptosis surgery and upper eyelid blepharoplasty surgery are the amongst
the most common reconstructive surgeries performed by Dr. Shome
Cause:
Ptosis occurs when the muscles that raise the eyelid (levator and
Müller's muscles) are not strong enough to do so properly. It can
affect one eye or both eyes and is more common in the elderly, as
muscles in the eyelids may begin to deteriorate. One can, however, be
born with ptosis. Congenital ptosis is hereditary in three main forms.
Causes of congenital ptosis remain unknown. Ptosis may be caused by
damage/trauma to the muscle which raises the eyelid, or damage to the
nerve (3rd cranial nerve (oculomotor nerve)) which controls this
muscle. Such damage could be a sign or symptom of an underlying disease
such as diabetes mellitus, a brain tumor, and diseases which may cause
weakness in muscles or nerve damage, such as myasthenia gravis.
Types of Ptosis:
Depending upon
the cause it can be classified into:
• Neurogenic ptosis which includes oculomotor nerve palsy, Horner's
Syndrome, Marcus Gunn jaw winking syndrome, IIIrd 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[2] by
elapids such as cobras,[3] or kraits.[4] 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:1-Lack of lid support:Empty socket or atrophic
globe. 2-Higher lid position on the other side: As in lid retraction
Treatments
Aponeurotic and congenital ptosis may require surgical correction if
severe enough to interfere with vision or if cosmesis is a concern.
Treatment depends on the type of ptosis and is usually performed by an
ophthamolic 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.
Ptosis that is caused by a disease will improve if the disease is
treated successfully.
Some patients have enough extra skin and fat in the upper eyelids or
enough drooping of the upper eyelids that it blocks a portion of the
peripheral vision. This can cause problems keeping the eyelids open
when driving a car or when reading. In these cases, upper eyelid
blepharoplasty surgery to remove the excess skin and fat or ptosis
surgery to tighten the droopy eyelid muscle may improve the peripheral
vision. If your eyelids are blocking your peripheral vision,
The Esthetic Clinic will work on your behalf to get the surgery authorized
by your insurance company.
It is also common for patients to have cosmetic lower eyelid surgery
and cosmetic eyebrow or forehead lift surgery performed simultaneous
with the reconstructive upper eyelid surgery. At
The Esthetic Clinic,
we find that patients who choose procedures that improve both form and
function are the happiest with their post-operative result.
To listen to a
patients’s account of ptosis:
http://www.youtube.com/watch?v=KPf7rk1Zyoc&feature=related
To look at a
video of ptosis surgery:
http://www.youtube.com/watch?v=_XU1BJaoEVE&NR=1
