Ptosis (eyelid)

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Ptosis (eyelid)
A patient with ptosis
Synonyms	Blepharoptosis
Pronounce	N/A
Specialty	N/A
Symptoms	Drooping of the upper eyelid
Complications	Amblyopia, astigmatism, strabismus
Onset	Can be congenital or acquired
Duration	Varies
Types	N/A
Causes	Congenital ptosis, neurological disorders, muscle diseases, trauma
Risks	Family history, aging, diabetes, stroke
Diagnosis	Physical examination, Hertel exophthalmometry, MRI
Differential diagnosis	Dermatochalasis, brow ptosis, pseudoptosis
Prevention	N/A
Treatment	Surgery, ptosis crutch, eyelid tape
Medication	None specific
Prognosis	N/A
Frequency	Common
Deaths	N/A

Edward I and Eleanor

Phineas Gage

Forest Whitaker at Cannes 2013

Ptosis (blepharoptosis) is a medical condition characterized by the drooping or falling of the upper eyelid. This condition may worsen after being awake for an extended period, as the individual's muscles become fatigued. Ptosis is sometimes mistakenly referred to as "Whitaker eye," but that term usually describes the condition amblyopia. If left untreated, severe ptosis can lead to other conditions, such as amblyopia or astigmatism. It is crucial to treat ptosis in children at a young age to prevent interference with vision development.

Causes

Ptosis can be caused by several factors, including:

• Congenital ptosis: Some individuals are born with ptosis due to a developmental issue with the levator muscle responsible for lifting the eyelid.
• Aponeurotic ptosis: This form of ptosis is caused by the stretching or dehiscence of the levator aponeurosis, often resulting from aging, eye surgery, or trauma.
• Neurogenic ptosis: Damage to the nerves controlling the eyelid muscles can result in ptosis. Conditions such as Horner's syndrome, myasthenia gravis, and third cranial nerve palsy are associated with neurogenic ptosis.
• Mechanical ptosis: An increase in weight of the upper eyelid due to tumors, swelling, or scarring can cause mechanical ptosis.

Diagnosis

A thorough medical history and physical examination are required to diagnose ptosis accurately. Additional tests may be performed to determine the cause and severity of ptosis, including:

• Visual acuity testing
• Slit-lamp examination
• Tension test for myasthenia gravis
• Imaging studies, such as MRI or CT scan

Treatment

The treatment for ptosis depends on the underlying cause and severity of the condition. Some treatment options include:

• Observation: In mild cases of ptosis, no treatment may be necessary, and the condition can be monitored over time.
• Eyelid crutches or tape: These non-surgical options can temporarily alleviate ptosis by providing support to the drooping eyelid.
• Surgery: Surgical procedures, such as levator resection or frontalis sling, can be performed to correct ptosis and restore proper eyelid function. The choice of surgery depends on the cause and severity of the ptosis, as well as the strength of the levator muscle.
• Treatment of underlying conditions: If ptosis is caused by an underlying medical condition, such as myasthenia gravis, treating the primary condition may improve ptosis symptoms.

Prognosis

The prognosis for individuals with ptosis varies depending on the underlying cause, severity, and response to treatment. In many cases, surgical intervention can effectively correct ptosis and restore normal eyelid function. Early detection and treatment are particularly important in children to prevent the development of vision problems, such as amblyopia or astigmatism.

References

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