Ptosis is the medical term for drooping of the upper
eyelid, a condition that may affect one or both eyes.
When the edge of the upper eyelid falls, it may block
the upper field of your vision. Ptosis that is present
at birth is called congenital ptosis.
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(s). You may
also notice that you have a tired appearance from "droopy
eyelids" even though you are well rested.
Acquired ptosis is most commonly due to stretching
of the levator muscle in the eyelid. The levator muscle
is the major muscle responsible for elevating the upper
eyelid. Another cause of acquired ptosis is interference
with the nerve supply to the muscle. Acquired ptosis
may occur as a result of aging, trauma, or muscular
or neurologic disease.
As you get older, the tendon
that attaches the levator muscle to the eyelid stretches
and the eyelid may
fall, covering part of the eye. It is not uncommon
for a patient to develop upper eyelid ptosis after
cataract surgery, which can sometimes cause the
weak tendon to stretch.
Acquired ptosis can also
be caused by injury to the oculomotor nerve (the
nerve that stimulates the
levator muscle), or following severe trauma to the
eye's orbit that injures the tendon connecting the
levator muscle to the eyelid.
Acquired ptosis may
also be the first sign of myasthenia gravis, a disorder
in which the body’s 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.
While the cause of congenital ptosis is often unclear,
the most common reason is improper development of
the levator muscle.
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,
a "sling" may be used to enable the forehead
muscles to elevate the eyelid.
If congenital ptosis
is not severe, surgery is generally performed when
the child is between 3
and 5 years of age. However, when the ptosis interferes
with the child's vision, surgery is performed at
an earlier age to allow proper visual development.
main goals of ptosis surgery are elevation of the
upper eyelid to restore normal field of
vision and an attempt to achieve 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.
Some surgeons prefer to use general anesthesia,
in which case the patient will sleep through the