What is Ptosis?
Ptosis is a medical condition that is characterized by drooping of the eyelids. It is also called as blepharoptosis. Ptosis may affect any one eye (unilateral ptosis) or it may affect both eyes (bilateral ptosis). The condition may be intermittent (with phases of remission and recurrence) or a permanent condition. It is also classified as congenital (present at birth) or acquired (develops at later stage in life). Ptosis can block the affected individual’s vision, the extent of which depends on the severity of the condition. In some cases, the condition resolves by itself whereas in some cases, the condition requires medical attention.
Symptoms of Ptosis
The common symptoms of ptosis include:
- Drooping or sagging of both or one upper eyelids.
- Diminished vision.
- Dryness of eyes/excessive watering from eyes
- Tired or weak appearance of the face
- Tenderness around the eye area
Individuals with severe ptosis may have to tilt their head backwards to look at things around and also while having a conversation with another person.
Epidemiology of Ptosis
Ptosis affects men and women with equal prevalence. There is no substantial difference of prevalence within any ethnicity either. It has been seen that ptosis affects all age group; however, it is more common among older age groups than the younger population, possibly due to the aging process.
Causes of Ptosis
In most of the cases the exact cause of ptosis remains unknown. In some cases, it has been seen that the condition arise from trauma or other neurological condition. In congenital cases, it is caused due to poor development of the levator muscles. Children with ptosis have higher chances of developing amblyopia (lazy eye). Over a period of time ptosis can delay or limit the vision of the child.
Risk Factors of Ptosis
Risk factors associated with ptosis includes:
- Presence of Underlying Eye Condition as a Risk Factor for Ptosis: Unilateral ptosis is often linked with nerve injury or presence of a temporary stye. Ptosis may develop after a routine LASIK or cataract surgery as a result of abnormal stretching of muscle or tendons of the eyes.
- Other Medical Conditions as a Risk Factor for Ptosis: Droopy eyes may be associated with serious medical conditions such as brain tumor, cancer, stroke etc. Neurological issues such as myasthenia gravis that affects the muscles and nerves of the eye can also cause ptosis. It few cases, ptosis is associated with migraine headache.
Prognosis of Ptosis
Ptosis does not have harmful effect on the health. However, it affects the vision and in view of which patients with ptosis are advised to avoid driving. The prognosis of ptosis depends on the underlying cause of the condition. In most of the cases, it is a cosmetic issue which can be easily corrected. In other cases, there may be poor prognosis, if droopiness of the eyes is caused by certain serious medical condition.
Diagnosis of Ptosis
Diagnosis of ptosis is usually done by an experienced ophthalmologist. A detailed case history is obtained followed by a physical examination of the affected eye/eyes. A series of specialized tests are done to determine the cause of the condition. Some of these tests are mentioned below:
- Slit Lamp Exam to Diagnose Ptosis: Here the eyes are dilated and a high intensity light is used to take a close look of the eye.
- Tensile Test to Diagnose Ptosis: In this a test a special drug called as Tensilon (Edrophonium) is injected into one of the veins after which the patients is asked to do few exercises. This test is used to determine the presence or absence of a condition called as myasthenia gravis (affecting the eyes).
Treatment and Management of Ptosis
Treatment of ptosis depends on the severity of the condition and it also depends on the underlying cause of the condition. Ptosis caused by aging or if present at birth may not require any treatment. However, the affected individual can consider plastic surgery for cosmetic correction of the eyelid. In cases where ptosis is caused due to presence of other medical conditions, the causative factor is treated first. The treatment methods are as follows:
- Surgical Correction for Treating Ptosis: Ptosis surgery is done to tighten the levator muscles. This helps is lifting the eyelid to a desired position. There are curtains risks involved with this surgery which includes development of dry eyes, scratched cornea, hematoma etc. In some cases, a ‘sling operation’ is done, where the forehead muscles are used to lift the eyelids to a close to normal position.
- Ptosis Crutch for Managing Ptosis: This is a non-surgical option, where an attachment is added to the frame of the glasses. This attachment is called as a crutch and it prevents drooping of the eyelids. There are 2 types of crutches that are used for management of ptosis: adjustable and reinforced. The former is attached to one side of the frame, where the latter is attached to both sides of the frame. These crutches can be attached to any frame; however, they work best on metal frames.
Prevention of Ptosis
There are no known preventative measures that can help is prevention of ptosis. Regular eye check- ups can help in early diagnosis which in turn can help is early management of the condition. Children with symptoms of ptosis are advised to consult an ophthalmologist at the earliest. It is important to get ptosis evaluated and treated as it affects the vision of the individual and the condition tends to worsen when there is lack of active treatment.
Ptosis is a symptom rather than a medical condition where there is drooping of any one or both eyelids. It is generally caused due to presence of other medical conditions. Sometimes the condition is present since birth and it is known as congenital ptosis. Besides the classic droopiness, it is also associated with other symptoms such as visual disturbances, tenderness and generalized irritation of the eyes. Diagnosis and treatment of ptosis is done by an ophthalmologist. Diagnostic tests include specialized tests such as split lamp test and tensile test. Treatment of droopy eyes depends on the cause of the condition. Besides treating the underlying condition, treatment of ptosis is done by surgical invasion. Other option includes using a ptosis crutch.