If asked about a medical problem that can affect the eye, many people would probably think about traumatic injuries or age-related diseases. But not every medical problem that interferes with our ability to see develops within our actual eyes. An example of such a problem is ptosis.

What Is Ptosis?

“Ptosis” refers to a phenomenon where the upper eyelid begins to droop. While this may not initially sound like a big problem, ptosis can actually become so severe that it interferes with a patient’s ability to see and go about their daily life in a normal manner. Seeing as this medical problem affects both adults and children, it’s important to know what causes this issue and to understand what treatment will be needed to address it.

Causes Of Ptosis

There are multiple possible causes of ptosis. A common cause is the weakening of the muscles that control the eyelid; this weakening can occur in the muscles of both adults and children.

  • In adults, ptosis tends to develop because a tendon that attaches to the levator muscle – that is, the key muscle involved in lifting the eyelid – is stretched and weakened to the point that it no longer effectively pulls on the muscle.
  • In children, it’s a delayed development of some sort that usually results in the levator muscle being too weak to do its job effectively. No matter the cause of ptosis, however, patients eventually suffer from sagging in one or both eyelids.

While weakened muscles are the most common cause of ptosis, it can also develop for other reasons. 

  • Neurologic or Muscular Diseases: Certain diseases can impact the muscles and nerves in the eyelid, leading to ptosis.
  • Trauma: A traumatic event affecting the eye can increase the risk of developing ptosis.
  • Genetic Factors: In some instances, ptosis may be an inherited condition.
  • Cataract Surgery: This procedure may stretch the muscles and tendons responsible for controlling the eyelid, heightening the risk of ptosis.

Symptoms of Ptosis

Ptosis can sometimes be hard to identify. Pay attention to these key symptoms to help recognize them early.

  • Excessive eye rubbing
  • Reduced vision when looking up
  • Impaired overall vision
  • Visibly droopy eyelid

Why Is Ptosis So Problematic?

The degree of inconvenience caused by ptosis varies significantly, depending on the severity of the condition:

  • Minor Drooping: In some cases, ptosis results in only slight sagging of the upper eyelid. Though it can be a cosmetic issue, it typically does not obstruct vision in these instances.
  • Severe Drooping: In more severe cases, the drooping eyelid may descend low enough to cover the entire pupil. This can drastically limit or even entirely block a person's normal field of vision, leading to significant visual impairment.

People struggling with ptosis often face additional difficulties:

  • Difficulty Keeping Eyelids Open: Many individuals affected by ptosis have trouble keeping their eyelids fully open due to the sagging. This constant effort can lead to discomfort and fatigue.
  • Manual Lifting of Eyelids: In extreme cases, some people might need to use their hands or fingers to lift their drooping eyelids for clear vision. This can be inconvenient and disruptive to daily activities.

Who Is Affected By Ptosis?

Ptosis is a condition that doesn't discriminate based on age - it can affect both adults and children. However, the implications and potential complications can vary:

  • Adults: In adults, ptosis often results from aging, muscle damage, or a nerve problem. While it might be mostly a cosmetic issue for some, it can cause significant visual impairment in others.
  • Children: Unfortunately, children with ptosis face a higher risk of developing additional complications. These include:
    • Amblyopia: Also known as 'lazy eye,' this condition can develop if ptosis is not treated timely in children. It results in decreased vision in one eye compared to the other.
    • Developmental Delays: Limited vision due to ptosis can lead to developmental delays in some children if the issue isn't addressed promptly.
    • Eye Movement Abnormalities: Children suffering from ptosis are at an increased risk of experiencing other eye movement abnormalities.

Can Ptosis Be Corrected?

Yes. Ptosis can be corrected surgically during a procedure that tightens the levator muscle or Mueller’s muscle; this tightening gives the individual an improved ability to lift their eyelid. In extreme cases, surgeons may carry out an operation known as a “frontalis sling” operation, which gives a patient’s forehead muscles control over the eyelid. They can help return a patient’s field of vision to normal. Either way, the surgeon in charge will aim to give their patient full control over their eyelids and a full field of vision after treatment.

If left untreated, severe ptosis can lead to complications such as:

  • Astigmatism: This occurs when the eyelid puts pressure on the front of the eye, changing its shape and potentially causing distorted vision that may appear stretched or wavy.
  • Amblyopia: Also known as 'lazy eye,' this condition can be caused by astigmatism and other refractive errors, which are issues with focusing due to a need for glasses.
  • Chin-up position: If a child with ptosis has to constantly tilt their chin up to see beyond their drooping eyelids, it may lead to neck problems, tightened forehead muscles, and developmental delays.

Diagnosis and Tests For Ptosis

Diagnosing ptosis typically involves several steps:

  • Medical History: The doctor begins by taking a detailed medical history, asking about the onset and duration of symptoms, any changes or fluctuations in the eyelid position throughout the day, and any family history of ptosis.
  • Physical Examination: A comprehensive eye examination is performed. The doctor will assess the eyelids' appearance and position, evaluate the eyelid muscles' strength, and measure the opening between the upper and lower eyelids (palpebral fissure).
  • Visual Acuity and Visual Field Testing: These tests are done to check how well the person can see and whether their field of vision is affected by the drooping eyelid.
  • Photographic Documentation: Photos may be taken for documentation and to help evaluate the degree of ptosis and its change over time.
  • Additional Tests: If the doctor suspects that ptosis is caused by an underlying condition, further tests may be ordered. For instance, a Tensilon test might be performed if myasthenia gravis is suspected, or imaging tests like a CT scan or MRI might be done if a neurological cause is possible.

Everett & Hurite Eyecare Specialists: Your Partner in Eye Health

At Everett & Hurite Eyecare Specialists, we prioritize diagnosing and treating conditions like ptosis, recognizing the significant impact they can have on our patients' lives. Our experienced team is equipped to identify early signs of ptosis and guide you through the best treatment options available. We are committed to restoring your or your child’s vision to normalcy.

If you or your child experience symptoms of ptosis, such as drooping eyelids, do not hesitate to contact us. We are here to provide comprehensive care and refer you to specialized treatment if necessary. Schedule your appointment with Everett & Hurite Eyecare Specialists today, and take a step towards a clearer, healthier vision.

Frequently Asked Questions

Are there any non-surgical treatment options for ptosis?

Non-surgical treatment options for ptosis are limited. In some cases, special glasses with a crutch or prop can be used to lift the drooping eyelid temporarily, but they do not provide a permanent solution. Surgical correction is typically the most effective treatment method.

What are the potential risks and side effects of ptosis surgery?

As with any surgical procedure, there are potential risks and side effects. These can include infection, bleeding, scarring, asymmetry, dry eyes, changes in eyelid position, and temporary or permanent changes in vision. Discussing these risks with your surgeon before undergoing ptosis surgery is important.

How long is the recovery period after ptosis surgery?

The recovery period after ptosis surgery can vary depending on the individual and the extent of the procedure. Generally, it can take several weeks for the initial swelling and bruising to subside, and full recovery may take a few months. Your surgeon will provide specific instructions for post-operative care and follow-up appointments.

Can ptosis recur after surgical correction?

While surgical correction of ptosis is typically successful, there is a small chance of recurrence. Factors such as age, underlying health conditions, and individual healing responses can contribute to the risk of recurrence. Regular follow-up appointments with your surgeon can help monitor the long-term success of the procedure.