Ptosis Of The Eye

5 min read

Ptosis of the eye is a drooping of the eyelid. It usually refers to the upper eyelid but doctors can also reference ptosis of the lower eyelid, but this is much less common. Ptosis of the eyelid can have many different causes. The cause may be a problem with the muscles in the eyelid or in the upper part of the face and brow, or the problem could be a problem with the nerve that is associated with those muscles. While most cases of ptosis happen in adults, there is a form of ptosis that children can be born with. 

Eye Ptosis Symptoms

Symptoms of ptosis are fairly obvious when the ptosis is significant. Usually, the patient or the parent will notice the problem and make the eye doctor’s appointment to address the ptosis. Sometimes if ptosis is subtle, it may be picked up by a doctor during an eye exam. Patients may also complain that their eyes get tired when they are trying to read or watch TV. This is because they may be raising their eyebrows in order to help keep their eyelid open. 

Tests For Eye Ptosis

When you see an eye doctor for ptosis of the eye, the doctor will perform a few tests. The first is a basic eye exam. The doctor will make sure that the ptosis is not associated with any other concerning symptoms. Some worrisome symptoms would be having difficulty to move the eye in a certain direction or having a difference in pupil size, called anisocoria. Anisocoria and ptosis together could mean you have Horner’s syndrome. 

In addition to doing a complete eye exam, your doctor may also perform a visual field. This test is usually done in the office and it can measure if there’s any degree of visual field loss from the ptosis. The visual field may be done with the eyelid taped up. This can help the doctor to figure out if lifting the eyelid will improve the patient’s field of vision.

Treatment For Ptosis

Depending on the cause, ptosis is treated in different ways. If ptosis is related to a medical condition like Horner’s Syndrome, that must be fully worked up by a doctor. 

The most common treatment for ptosis is surgical correction. There are many different types of surgeries for ptosis correction and an ophthalmologist who specializes in oculoplastics is the best type of doctor to help you. An oculoplastics specialist can evaluate which muscles in and around your eye and eyelid are causing the ptosis. They will choose a surgical procedure based on their findings.

The most common complication of surgical ptosis repair is an undercorrection of the ptosis. This happens in about 10 to 15% of cases. Overcorrection can also happen and in both cases your surgeon will likely wait until any eyelid edema or other post operative changes have stabilized. In cases of overcorrection, patients may be able to massage the eyelid for a mild improvement. Another side effect of ptosis surgery is that the prescription of the eye may change. In 72% of patients who undergo surgical treatment for ptosis, a change in astigmatism may happen. 

Treatment for ptosis is especially important in children. When children are young, their vision is developing. If a child has a droopy eyelid from ptosis, it blocks their vision. This has a negative impact on a child’s visual development. Ptosis in a child can lead to a disease called amblyopia. In amblyopia, the visual pathways do not develop correctly and a child’s vision is permanently decreased. If your child has a droopy eyelid, see a pediatric ophthalmologist right away.  

What Causes Ptosis?

Ptosis can have many different causes. 

A nerve problem can cause ptosis. Cranial nerve 3 controls the movement of many eye muscles including the Levator palpebrae superioris, which raises the upper eyelid. If the 3rd cranial nerve is injured or has a palsy, a patient may have ptosis. In the case of a 3rd nerve palsy, patients may also have abnormal eye movements, since the third nerve controls 4 other eye muscles.

Other diseases like myasthenia gravis, or myotonic dystrophy can also cause eyelid ptosis. These diseases affect muscles and can cause muscle weakness. 

The eye muscle itself could be weak and this can also cause ptosis. An injury to the eye muscle itself can also cause ptosis.

Ptosis Of The Eye: Take Home Points

Ptosis can be a result of a variety of different problems both in the eye and even in the brain and body. The most common way to treat ptosis is through surgery. The type of surgery is usually determined by an oculoplastic surgeon. In children, ptosis that is left untreated can cause amblyopia, and these patients need to be seen by a pediatric ophthalmologist right away. 

Sources:

Díaz-Manera J, Luna S, Roig C. Ocular ptosis: differential diagnosis and treatment. Curr Opin Neurol. 2018 Oct;31(5):618-627.

https://pubmed.ncbi.nlm.nih.gov/30048338/

SooHoo JR, Davies BW, Allard FD, Durairaj VD. Congenital ptosis. Surv Ophthalmol. 2014 Sep-Oct;59(5):483-92. doi: 10.1016/j.survophthal.2014.01.005. Epub 2014 Feb 5. PMID: 24657037.

https://pubmed.ncbi.nlm.nih.gov/24657037/

https://eyewiki.org/Aponeurotic_Ptosis

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