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 Dr. Sanjay Dhawan
What is it?
What Causes it?
Who are at risk?
What are the symptoms & signs?
How is it diagnosed?
What is the treatment?
What are the surgical options?
What is it?

Ptosis is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision. It can be present in children as well as adults and may be treated with surgery.

What Causes it?

2-Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as neurological and muscular diseases and, in rare cases, tumors of the eye socket.Congenital ptosis is often caused by poor development of the levator muscle that lifts the eyelid.

Although it is usually only a problem with a drooping eyelid, a child born with ptosis may also have eye-movement abnormalities, muscular diseases, lid tumors, or other tumors, neurological disorders or refractive errors.

Who are at risk?

Patients having Congenital (present since birth)drooping of eye lid due to a poorly developed muscle. It is more common in older adults where the muscle that lifts the eyelid thins and the eyelid drops. It occurs with age, contact lens wear, trauma and, rarely, tumour or from a neurological problem, such as a nerve palsy or muscle weakness (myopathy).

What are the symptoms & signs?

Ans 4- The symptoms of ptosis are a drooping of the upper eyelids. This can be in just one eye, or it may affect both eyes.

Ptosis generally gives the face a tired or severe appearance. However, it can also result in both dry eyes and watery eyes, as the eyelids are no longer functioning effectively to keep the eyes moist.

At its most severe, ptosis can obstruct the vision, as the upper eyelid sags so much that it begins to cover the pupil. Many people with severe ptosis find themselves tilting their heads back to speak. Ptosis can also cause tiredness and aching around the eyes, as the eyebrows are constantly lifted in order to see properly.

How is it diagnosed?

A physical examination will be done to determine the cause.
Tests that may be performed include:

Slit-lamp examination
Tension test for myasthenia gravis
Visual field testing.

What is the treatment?

If age-related ptosis blocks vision or seriously affects appearance, a plastic surgeon usually can correct the problem by surgically raising eyelid. In most adult patients, this is an outpatient procedure that is done under local anesthesia. Local anesthesia is preferred over general anesthesia because it allows the surgeon to adjust the position of eyelids while eyes are open.

If baby is born with severe congenital ptosis, doctor probably will recommend prompt corrective surgery because early treatment reduces the risk of permanent vision damage. If child has milder ptosis without impaired vision, however, the doctor may suggest waiting until the child is 3 to 5 years old to correct the drooping eyelid. During childhood, eyelid surgery is performed under general anesthesia.

If you have ptosis that is caused by a muscle disease, neurological problem or local eye problem, your doctor will treat the illness. In some cases, this treatment either improves the drooping eyelid or keeps it from getting worse.

What are the surgical options?

If a disease is found, it will be treated. Most cases of drooping eyelids are due to aging and there is no disease involved.

Eyelid lift surgery (blepharoplasty) is done to repair sagging or drooping upper eyelids. In milder cases, it can be done to improve the appearance of the eyelids.

In more severe cases, surgery may be needed to correct interference with vision.

In children with ptosis, surgery may be needed to prevent amblyopia, also called "lazy eye."

What are the outcomes?

In most cases, the outlook is good. Surgery usually can correct the drooping eyelid in children with congenital ptosis and adults with age-related ptosis. In some cases, corrective surgery causes the eyes to remain open slightly during sleep, so a nighttime lubricant is applied to the eyes to prevent drying.

What are the complications?

In children, the most serious complication of ptosis is a lazy eye (amblyopia). A lazy eye is when you can't see properly through one of your eyes. This is because the developing brain ignores the image sent to it in favour of the image received from the better-seeing eye. A lazy eye can be reversed, for example by correcting the position of the lid. After the age of eight, the visual pathways have developed and it may be impossible to reverse any loss of vision in a lazy eye.

Children can be more sensitive to the visible effects of a ptosis and the condition may lead to emotional problems.

In both adults and children, ptosis can disrupt vision and making it difficult to carry out everyday activities such as reading, navigating stairs or driving. For some people, this may cause headaches, usually at the front of the head.

What is the time course?

Ans 10-The time course depends upon the severity and strength of ptosis. Ptosis is often a long-term problem. In most children with untreated congenital ptosis, the condition is fairly stable and does not get worse as the child grows. In people with age-related ptosis, however, the drooping can increase gradually over the years.

What is the expense?

The expense depends upon the grades of treatment.

Author: Dr. Sanjay Dhawan
Last Updated on: 1 March, 2014

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