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Blepharoptosis, also known as ptosis, is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes.
CAUSES OF PTOSIS
Ptosis may be congenital (present at birth) or acquired with age. Acquired ptosis is most commonly due to stretching of the eyelid lifting muscle (known as the levator muscle) within the upper eyelid. The levator muscle is the major muscle responsible for elevating the upper eyelid. The most common reason for a stretched eyelid lifting muscle is aging. Other causes of acquired ptosis include trauma, muscle degeneration or interference with the nerve supply to the levator muscle. Ptosis may result from repeated stretching of the upper eyelid during the removal of contact lenses or may occur following eye surgery. Rarely, ptosis may also be the first sign of myasthenia gravis, a disorder in which the muscles become weak and tire easily. Ptosis is also present in people with Horner's syndrome, a neurologic condition that affects one side of the face and indicates injury to part of the sympathetic nervous system.
The exact cause of congenital ptosis is often unclear but the most common reason is improper development of the levator muscle. Children with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows in an effort to see. Children with congenital ptosis may also have a lazy eye (a condition known as amblyopia), a crossed or wandering eye (a condition in which the eyes are not properly aligned known as strabismus) or significant refractive problems such as far sightedness, near sightedness, or astigmatism.
As the upper eyelid droops, it may block the upper field of your vision. Symptoms of ptosis include a decreased ability to keep your eyes open, eyestrain and eyebrow fatigue from the increased effort needed to raise your eyelids, and fatigue, especially when reading. In severe cases, it may be necessary to tilt your head back or lift the eyelid with a finger in order to see out from under the drooping eyelid. In these instances, ptosis repair is
considered medically necessary and is usually covered by insurance. When eyelid surgery is performed to improve one’s appearance in the absence of any signs or symptoms of functional abnormalities, the procedure is considered cosmetic and is performed at the expense of the individual.
Since there are many causes of ptosis, it is important to undergo evaluation by a qualified physician who can properly evaluate and treat a patient with ptosis. During your initial evaluation, your doctor will perform a complete eye examination. The degree of impaired vision will be determined by a test of your field of vision. Ptosis is diagnosed by observing the degree of eyelid droop and by measuring the strength of the eyelid lifting muscle. Finding the underlying cause of the condition sometimes requires additional testing for any of the illnesses or injuries known to cause ptosis.
Treatment of Acquired Ptosis
Acquired ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. Surgery is designed to reattach the stretched muscle to its normal location. If there is poor strength in the levator muscle, an implant known as a "sling" may be implanted to aid in the elevation of the droopy eyelid.
Treatment of Congenital Ptosis
Congenital ptosis is also treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. If the ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age during the preschool years. However, when the ptosis interferes with the child’s vision, surgery is performed at an earlier age to allow proper visual development. As with acquired ptosis, surgery usually involves tightening the levator muscle in order to elevate the eyelid to the desired position. In severe ptosis, the levator muscle is extremely weak and a "sling" operation may be performed, enabling the forehead muscles to elevate the eyelid.
The main goals of ptosis surgery are elevation of the upper eyelid, restoration of the normal field of vision, and improved symmetry with the opposite upper eyelid. These goals depend on many factors and, therefore, may not always be possible to achieve.
Surgery is usually performed with local anesthesia, which numbs the upper eyelid, and with the patient lightly sedated with oral and/ or intravenous medications. This allows for intra operative adjustments and helps ensure a successful outcome. Some surgeons prefer to use general anesthesia, particularly for children in which case the patient will sleep through the operation.
In general, complications of ptosis repair are rare and minor when performed by a surgeon trained in the surgical techniques. However, it is possible for the patient to experience incomplete eyelid closure, over or under correction, dry eye and other unintended outcomes.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.