ptosis

What is ptosis?

Ptosis is a drooping or falling of the upper eyelid. The eyelid may droop just a little, or so much that it covers the entire pupil. In some cases, ptosis can limit or even completely block normal vision.

Ptosis can affect one or both eyes; it can be hereditary, it may be present at birth (congenital) or develop at an older age (involutional ptosis).

Ptosis in children

Congenital ptosis means having ptosis at birth. If a child is born with moderate to severe ptosis, immediate treatment may be required for the vision development.

Congenital ptosis often occurs due to a defect in the development of the elevating muscle of upper eyelid called the levator. Although usually a distinct dystrophy, in congenital cases, it may be accompanied by the following disorders:

• Eye movement disorder
• Muscular disorders
• Eyelid tumors or other tumors
• Neurological disorders
• Refractive errors

Congenital ptosis usually does not improve over time.

What are the symptoms of ptosis?

The most common symptom of ptosis in children is drooping of the eyelid. In congenital ptosis the upper eyelid creases do not line up evenly with each other. Children with ptosis may have to bend their necks backward or raise eyebrows to see well. These head and face movements show that the child tries to use both eyes to see. Over time, these abnormal head movements can cause head and neck problems.

What are the problems associated with ptosis in children?

The most common serious disorder associated with childhood ptosis is amblyopia (lazy eye). Ptosis can cause amblyopia or lazy eye for two reasons: If the ptosis is severe, it may block vision, develop astigmatism and resulting in blurred vision, In addition, ptosis may hide it if there is any eye deviation which this can also lead to lazy eye.

How is congenital ptosis treated?

In most cases, ptosis in children is treated with surgery. If there is also lazy eye, Treatment may be necessary by putting a patch over the healthy eye, wearing spectacles or using eye drops. Surgical diagnosis and choice of an appropriate surgical procedure are based on the following factors:

• Child's age
• Affecting one eyelid (unilateral) or both eyelids (bilateral)
• Ptosis severity
• Strength of lifting and lowering eyelid muscles
• Eye movements status

In mild to moderate ptosis there is usually no need for surgery early in life. Both in the above mentioned cases and in severe cases undergoing surgery, they should be monitored regularly by the ophthalmologist for lazy eyes, refractive errors and related conditions and treated if needed.

What causes ptosis in adults?

The most common cause of ptosis in adults is stretching or separation of the levator muscle tendon from the eyelid. The occurrence of this process may be due to the following causes:

• Aging
• Following (complication of) cataract surgery or other ophthalmic surgeries
• Eye trauma

Ptosis in adults may also be a complication of other diseases, such as neurological or muscular diseases, and in rare cases, eye tumors that affect the elevating muscle of upper eyelid (levator) or its nerve.

How is ptosis in adults treated?

An ophthalmologist can make a comprehensive assessment of your problem and provide you with information about the different treatments and their possible side effects and risks. Blood tests, special imaging or other examinations may be required to determine the cause of ptosis and to choose the best treatment. If the underlying cause is found it should be corrected first, but in most cases the final treatment is surgery the type of which is determined by the severity of the ptosis and other clinical findings.

What Are The Risks Of Ptosis Surgery?

The risks of ptosis surgery include infection, bleeding and reduced vision, but these complications occur very infrequently. Immediately after surgery, you may find it difficult to completely close your eye, but this complication is only temporary. Lubricant eye drops and ointment can be helpful during this period. Although the appearance of the eyelid is significantly improved, the eyelids may not still look quite symmetric. In most cases, after surgery, the treated eyelid is slightly higher than the other side when looking down and remains slightly open at nights, which is not a problem. In rare cases, complete eyelid movements cannot be reversed. In some cases, surgery may be needed more than once. Ptosis in adults and in children can be treated with surgery which in addition to improving the cosmetic appearance, it can also correct vision. In childhood eyelid ptosis, regular ophthalmologic examinations in the early years of life are especially important for prevention and treatment of possible lazy eye.