What Is Ptosis?
Ptosis is a drooping of the upper eyelid. This drooping may be slight or may cover the entire pupil. In some cases, ptosis can reduce the normal vision or even completely block it. Ptosis can:
• Develop in one or both eyes.
• Be congenital.
• Develop at the time of birth.
• Occur in older ages.
Ptosis in Children
Congenital ptosis is the presence of ptosis at birth. If a child is born with moderate to severe ptosis, it may need immediate treatment for visual development.
Congenital ptosis often occurs due to developmental defects in the elevating muscle of the upper eyelid that is called the levator muscle. Ptosis is usually a distinct disorder; however, in congenital cases, it may be accompanied by the following disorders:
• Eye movement disorders
• Muscular disorders
• Eyelid tumors or other tumors
• Nervous system disorders
• Refractive errors
Congenital ptosis does not usually improve over time.
What Are the Signs and Symptoms of Ptosis?
The most common symptom of ptosis in children is droopy eyelids. In congenital ptosis, there is often an asymmetry of the upper eyelid crease. Children with ptosis may have to tilt their head backwards or raise eyebrows in order to see. These facial and cervical positions indicate that the child takes effort to use both eyes to see, which after several years, may lead to abnormal head and neck postures.
What Are the Problems Caused by Ptosis in Children?
The most common disorder associated with childhood ptosis is amblyopia (lazy eye). Ptosis may cause amblyopia for two reasons:
• Visual axis occlusion in cases of severe ptosis
• Astigmatism, and blurred vision as a result
In addition, ptosis may conceal any possible strabismus, and this can also lead to amblyopia.
How to Treat Congenital Ptosis?
In most cases, ptosis in children is treated with surgery. If amblyopia is also present, it would be necessary to be treated by covering the good eye with a patch, putting eye drops or wearing eyeglasses. The necessity of surgery and the appropriate method are determined based on the following factors:
• Child’s age
• Whether one or both eyes are affected
• Ptosis severity
• The power of levator and depressor muscles of eyelid
• Status of the ocular muscles
Surgery is usually not necessary for mild to moderate ptosis in early life. In these cases and also in severe ones in which surgery is performed, the patient should be regularly examined by the ophthalmologist for any possible amblyopia, refractive errors, and relevant conditions, and be treated if necessary.
What Causes Ptosis in Adults?
The most common cause of ptosis in adults is levator muscle tendon being stretched or detached from the eyelid. This process may occur due to following reasons:
• Ageing process
• After cataract surgery or other ocular surgeries
• A blow to the eye
Adult ptosis may also develop as a complication of other diseases, such as neurological or muscular diseases, and rarely, orbital tumors, which engage the levator muscle of the eyelid or its nerves.
How to Treat Ptosis in Adults?
An ophthalmologist can perform a comprehensive examination of your problem and give you the information you need about the different treatment options, and their possible risks and complications.
Diagnosing the cause of ptosis and choosing the best treatment may require blood tests, special photography, or other types of tests. In case of finding the underlying causes, they should be corrected at first; however, in most cases, the final treatment is surgery, and its method depends on the severity of ptosis and other clinical findings.
What Are the Risks of Ptosis Surgery?
Infection, hemorrhage and reduced vision might be among the risks of ptosis surgery; however, these complications rarely occur. Immediately after the surgery, the eye may not be completely closed, but this is usually temporary. During this period, eye drops and ointments can be used to protect the eye. Although the eyelid appearance significantly enhances, the two eyelids may not appear to be perfectly symmetrical. In most cases after surgery, the operated eye is slightly higher than the opposite one while patient looks downward, and also remains slightly open at nights. These two complications are not problematic though. In rare cases, full eyelid movement does not return. In some cases, more than one surgery may be required.
In both adults and children, ptosis can be treated by surgery, which may also improve the visual acuity in addition to enhancing the appearance. Regarding the ptosis in children, regular ophthalmologic examinations are essential in preventing and treating any possible amblyopia, in the first years of life.