DROOPY EYELIDS

Our eyes narrate our emotions and stories to the world without uttering a single word. But what if, instead of an open book, they turned secretive, veiled by the dropping of one or both eyelids?

Ptosis, or the drooping of one or both upper eyelids, is a quiet adversary that, if left unaddressed, can obscure the world we perceive.

 

It is said that our eyes are the windows to our souls, but what if these windows to our souls were shrouded by an uninvited curtain, causing them to droop and dim? Our eyes narrate our emotions and stories to the world without uttering a single word. But what if, instead of an open book, they turned secretive, veiled by the dropping of one or both eyelids? This is a condition that transcends age, affecting both the youngest among us and those who have witnessed the passage of time. Ptosis, or the drooping of one or both upper eyelids, is a quiet adversary that, if left unaddressed, can obscure the world we perceive. Join us on a journey as we unveil the secrets of ptosis, from its causes to its treatments, and discover how it influences our lives in ways we might never have imagined.

What is ptosis?

 Ptosis (Blepharoptosis) means drooping of the upper eyelid of one or both eyes. It can limit or even completely block vision and can affect both children and adults. Proper evaluation, diagnosis, and accordingly, treatment are the key to management of ptosis.

• CONGENITAL PTOSIS:

It is a condition characterized by an abnormal drooping of one or both upper eyelids that is present at birth or shortly thereafter. 

CAUSES

It is most commonly due to maldevelopment of the levator palpebrae superioris muscle, the muscle that lifts the eyelid. In these cases, instead of a healthy functioning muscle to lift it, the eyelid has fibrotic (scar-like) tissue that allows very minimal movement of the eyelid, if any at all. 

Signs of Ptosis:

1. Drooping of upper eyelid 
2.  Absent lid crease or a faint crease
3. Affected eye looks smaller than normal
4. Positional changes in an attempt to see better : 

head tilt, chin lift, or raised eyebrows. 

Having ptosis puts a child at risk for vision problems. If the child’s eyelid droops so much that it blocks vision, amblyopia (also called “lazy eye”) can develop. One eye will have better vision than the other. A child with ptosis can also have astigmatism, where they see blurry images. The child may also develop misaligned (crossed) eyes.

• ACQUIRED PTOSIS:

It is defined as drooping of upper eyelid which is acquired later in adulthood. It can occur from many causes listed below:

• Aponeurotic ptosis (most common )

In this, the levator muscle of the eyelid becomes overstretched, usually due to aging. Excessive eye rubbing or eyelid pulling due to eye irritation or long-term contact lens use can also cause it.

 

• Neurogenic ptosis occurs when there is a problem with the nerve pathway that controls movement of the eyelid muscles. Causes include myasthenia gravis, third nerve palsy, and Horner’ syndrome. 

 

• Myogenic ptosis, the levator muscle is weakened due to a systemic disorder that causes muscle weakness. These conditions may include chronic progressive external ophthalmoplegia and types of muscular dystrophy.

 

• Mechanical ptosis where the eyelid is weighed down by excessive skin or a mass/tumor.

 

• Traumatic ptosis is caused by an injury to the eyelid—either due to an accident or other eye trauma. Here the injury compromises or weakens the levator muscle.

 

TREATMENT:

Oculoplastic surgeons consider the following factors when deciding the best way to treat ptosis:

• The child’s age
• Whether one or both eyelids are involved
• The eyelid height
• The strength of the eyelid’s muscle
• The eye’s movements

In most cases, we recommend surgery to treat ptosis in children. This is to either tighten the levator muscle or attach the eyelid to other muscles that can help lift the eyelid. The goal is to improve vision.

If the child also has developed lazy eye( amblyopia), that condition must be treated as well. Amblyopia may be treated by wearing an eye patch or special eyeglasses, or using certain eye drops, to strengthen the weaker eye.

All children with ptosis—whether or not they have surgery—should see their ophthalmologist regularly for eye exams.

 

SURGICAL MANAGEMENT OF PTOSIS:

The technique most suitable for each patient depends on the degree of eyelid ptosis and the strength of the muscle that lifts the eyelid (the levator palpebrae superioris). 

Mild eyelid ptosis with a strong levator muscle may be repaired with an internal approach through the inside of the eyelid, a procedure called conjunctivo-Mullerectomy. 

FIG: Left eye Mild ptosis corrected via Mullerectomy

Moderate ptosis with a functioning levator muscle may be repaired with an external approach through the eyelid skin, a procedure called levator advancement.

FIG: Right eye moderate ptosis corrected via Levator Advancement

 Severe ptosis with a weak or non-functioning levator muscle may be repaired with a procedure that involves taking advantage of the forehead muscles to lift the eyelids and open the eyes, a procedure called a frontalis sling. 

FIG: Right eye severe ptosis corrected via Frontalis Sling

In adults ptosis surgery is usually done as an outpatient procedure, which means you can go home the same day as the surgery. A local anesthesia will be used to numb your eye and the area around it.

However in children this has to be done under general anesthesia.