What is ptosis?
Ptosis is drooping of the upper eyelid. The lid may droop slightly or it may cover the pupil (the dark center of the eye). One or both eyelids may be affected.
Ptosis that is present at birth is called congenital ptosis. If the ptosis in one eyelid is severe, the child’s vision may not develop properly. This may lead to amblyopia (also called lazy eye, a condition in which the brain uses images only from the “good” eye). Ptosis that develops later is called adult or acquired ptosis.
How does it occur?
Congenital ptosis occurs when the levator muscle, the muscle that lifts the eyelid up, is poorly developed. Children with ptosis may have other problems, such as diseases of the muscles or nerves.
Acquired (adult) ptosis occurs when there is an abnormality in:
- the levator muscle
- the levator muscle tendon
- the nerve supply to the levator muscle
These conditions may be caused by:
- muscle or nerve disorders
- tumors or aneurysms
- an injury
- diseases such as diabetes that affect the nerves and muscles
If ptosis occurs suddenly, a brain aneurysm may be the cause. In this case it is a medical emergency.
What are the symptoms?
The drooping eyelid is the main symptom of ptosis. People with ptosis may tilt their heads back or raise their eyebrows to lift the eyelid. Adults may notice a loss of vision, especially in the upper part of their field of vision. After many years of holding their heads in abnormal positions, they may have deformities of the head or neck.
How is it diagnosed?
Drs. Bellotte will examine you thoroughly. He or she may order blood tests and brain imaging to determine the cause and the best treatment plan.
How is it treated?
The treatment for congenital ptosis is usually surgery to attach the levator muscle to the muscles on the brow. All children who have ptosis, whether they have had surgery or not, should have regular eye exams to check for problems that may develop.
Treatment for acquired ptosis depends on its cause. If ptosis is the result of muscle or nerve disease, the doctor will treat the disease first. If a tumor is the cause, it can sometimes be removed. If the ptosis is simply because of the normal aging process, Drs. Bellotte may recommend surgery to shorten the levator muscle or remove the extra skin weighing the eyelid down.
How long will the effects last?
Congenital ptosis will not get better without surgery. However, early correction will help the child to develop normal vision in both eyes.
Some acquired ptosis that is caused by nerve problems will improve without treatment. Some ptosis that is due to a muscle disease improves when the disease is treated with the proper medicines. Often the effects of ptosis last until the proper surgery is performed. Please see Brent Bellotte MD at West Boca Eye Center if you have any concern that your eyelids are drooping.