Drooping Eyelid (Ptosis)

Congenital ptosis means the presence of ptosis at birth. If a child is born with moderate to severe ptosis, the child’s visual development may require immediate treatment.

Congenital ptosis often occurs due to a defect in the development of the muscles that elevate the upper eyelid which called the levator muscles. Although usually it is a distinct disorder, in congenital cases, it may be accompanied by the following disorders:

• Eye movement disorders

• Musculoskeletal disorders

• Tumors of the eyelids or other tumors

• Neurological disorders

• Refractive errors

Congenital ptosis usually does not improve over time.

The most common symptom of ptosis in children is drooping of the upper eyelid. In congenital ptosis, there is often asymmetry of the eyelid creases. Children with ptosis may also tip their neck back frequently in an effort to see underneath the drooping lid, or raise their eyebrows a lot to try to lift up their eyelids. These head and face movements indicate that the child is trying to use both eyes. After several years, the abnormal head condition may lead to head and neck disorders.

What are the eye disorders caused by ptosis in children?

The most commonly reported serious disorder associated with childhood ptosis is amblyopia (lazy eye). Ptosis can lead to amblyopia due to two causes:

• The obstruction of the visual field in severe cases of ptosis.

• This may result in high levels of astigmatism and blurred vision. It is likely that strabismus (crossed eyes) of a child with ptosis isn't diagnosed and is hidden due to ptosis. In this situation strabismus may lead to lazy eye.

How is congenital ptosis treated?

Surgery in most cases is the best treatment for drooping eyelids. If Lazy eye is diagnosed at the same time, it may be necessary to cover up the healthy eye with an eye patch or gauze or use eye glasses or eye drops. An ophthalmologist monitors and prescribes the appropriate surgical procedure based on the following factors:

• The child's age

• Ptosis in one or both eyelids

• Ptosis severity

• The strength of the muscles which are responsible for lifting and lowering the eyelids

• The status of eye movements

In the first years of life there is usually no need for surgery for mild to moderate ptosis. Children with mild, moderate or severe ptosis, whether they have undergone surgery or not, should be regularly examined for amblyopia, refractive errors, and associated conditions by an ophthalmologist and should be soon treated if needed.

The most common cause of ptosis in adults is due to a stretching or thinning of the tendon of the levator muscle that lifts the eyelids called the levator aponeurosis. This condition may occur due to the following:

• Aging

• After an ocular surgery (Following cataract surgery or other ophthalmic surgeries)

• Eye trauma

Adult ptosis may also occur as the complication of other diseases, such as neurological or muscular disorders, and in rare cases, the tumor of the eyeball, which affects the 'levator' muscles that hold the eyelids up, or damages to the nerves that control these muscles.

How is ptosis in adults treated?

Ophthalmologists of Tehran-Iran Noor Eye Hospital can provide a comprehensive overview of your problem and provide you with information about the different treatment options and their possible side effects. Diagnosing the ptosis cause and choosing the best treatment may require blood tests, X-rays or other comprehensive examinations.

If the cause is diagnosed, it should first be treated, although in most cases the ultimate treatment for adult ptosis is surgery. The type of surgery is determined according to the severity of the ptosis and other clinical findings.

The risks of ptosis surgery include infection, bleeding and visual impairment, but the occurrence of these complications is very rare. Immediately after surgery, the eye may not completely close, but this is usually a temporary postoperative complication. Eye drops and ointments can be used during this period. Although the appearance of the eyelid is significantly improved, the eyelids may not appear to be perfectly symmetrical. In most cases, after surgery, when the patient looks down, the eyelid is often slightly upper than the opposite side eyelid, and at night the eyelid does not close completely during sleep, but these two complications are not problematic. In rare cases, full movements of the eyelid are not reversible. In some cases, a second surgery may be needed.

Summary

Ptosis in adults and children can be treated with surgery and this treatment can improve visual acuity in addition to improving the appearance. In congenital ptosis, regular ophthalmologic examinations in the first years of life are important for the prevention and treatment of probable laziness in the eye.