When one’s eyelid starts drooping and covering the pupil blocking the vision, it might become a cause of disruption in everyday life. When the eyelids droop or fall to a position which is lower than normal, it is known as ptosis or blepharoptosis. If only one eyelid is affected, it is known as unilateral ptosis however the condition is known as bilateral ptosis if it affects both eyelids. This condition can be present in an individual at birth which is known as congenital ptosis whereas if it is developed at a later stage in life, it is known as acquired ptosis.
In some people, the drooping eyelid might be slight and barely noticeable whereas in some people it can be drastic, and might block their vision and line of sight. In case of severe ptosis, other conditions like amblyopia or astigmatism might also develop. This is the reason why it is important for the condition to be treated properly in children of young age before it hampers the development of their vision. In most of the cases, the situation resolves with the help of medical intervention and sometimes the condition might cure itself naturally.
The condition occurs when the functioning of the levator muscle is compromised. This muscle is responsible for the function of lifting and dropping the eyelid. The different types of ptosis are:
- Neurogenic Ptosis: This type of ptosis occurs when the nerve pathways associated with the control of eyelids movement are not functioning properly. Some conditions that might cause this are third nerve palsy, Horner syndrome and myasthenia gravis.
- Congenital Ptosis: Some children are born with the condition of droopy eyelids. This happens because of the improper development of the levator muscle in the womb. It is important to look after this condition with utmost care. If it is not treated properly, the child might develop a lazy eye and might experience poor vision throughout his/her life. Annual examinations are recommended for children with ptosis. In early childhood, the shape of the eyes changes when they grow and ptosis might become worse. Surgery might be recommended to ensure proper development of vision.
- Aponeurotic Ptosis: This is the most common form of ptosis and occurs due to ageing. It is because of overstretching of the levator muscle due to which it does not function properly as before. A cause for this can also be the use of contact lens for a prolonged time and excessive rubbing of the eyes.
- Traumatic Ptosis: Any external injury or any incident that causes trauma to the eyes can also be a reason for developing ptosis. Precautions like wearing adequate protection of the eyes while playing sports and working with sharp materials like tools are necessary for maintaining good eye health and avoiding any hazardous incidents.
- Myogenic Ptosis: Disorders like muscular dystrophy leading to weakness of the muscles can lead to the development of ptosis as muscles in the body experience weakness. The levator can also be affected.
- Mechanical Ptosis: Weighing down of the eyelid due to excessive skin or mass might lead to the development of mechanical ptosis.
The most visible and common symptom is a drooping eyelid. People who are born with the disease have an uneven eye shape or might have a wrinkle on the eyelids. One or both the eyelids can be affected. In most people, the sagging of the eyelid is not very noticeable or might not happen at all times. Other symptoms might include a tired or weary-looking face, dryness in the eyes or watery eyes.
The problematic affected areas will be the area around the eyes. This leads to aching in the area and a worn out looking face. Individuals experiencing severe ptosis often have to tilt their heads back in normal situations to see, for example, while having a conversation with someone.
A doctor’s supervision is needed in case the condition persists in order to rule out any underlying conditions. It is important to do so if the person notices the appearance of migraine headaches and other related issues for the first time the drooping appeared.
Ptosis might present itself like dermatochalasis, a disorder in which the skin hangs in folds. It happens due to lower than the normal formation of the elastic tissue.
Ptosis happens due to the dysfunctioning of the muscles that are responsible for the nerve supply to the eyelids and for raising them. A cause for ptosis might be the damage of the muscle responsible for raising the eyelid, damaging of the superior cervical sympathetic ganglion or damage of the nerve which controls this particular muscle. This damage can also be an indicator of a more serious underlying condition like Pancoast a tumour, brain tumour diabetes mellitus or of disorders that cause weakening of the muscles or damage to the nerves like oculopharyngeal muscular dystrophy or myasthenia gravis. Exposing oneself to the toxins in some snake venoms, for example, the black mamba can also result in the development of this condition.
Aponeurosis of the levator muscle, trauma, inflammatory response in the lids, lesions of the lid, nerve abnormalities can be reasons for the development of ptosis. Elimination of the neurotransmitter due to the attack of autoimmune antibodies might result in the dysfunction of the levator.
Some other causes of this disorder include neurofibromas, eyelid neoplasms, Infection or tumor of the eyelid, tumor inside the eye socket, brain aneurysm, cancer of the nerves, Brain tumor, eye tumor, Bell’s palsy, side effect of a cataract surgery, Diabetes, Horner’s syndrome, Myasthenia gravis, side effect of a botox injection etc. Use of drugs like morphine and heroin can also cause mild ptosis.
There is no particular group recognized to be at a higher risk of ptosis. It can occur in men, women and in people of different ethnicities. It is most common in old people due to the natural ageing process. The levator muscle stretches with age and causes the eyelids to droop. Not just old people, but people of any age group can be affected by this condition. It is rare, but sometimes children are born with this condition.
The doctors will most likely take the patient’s physical examinations and run a medical history check on the patient. The doctors question the patient about how often their eyelids droop and the duration of the time it has been taking place. The doctors then run a few tests to determine the cause of the problem.
The doctors will conduct a slit lamp test so that they can take a closer look at the patient’s eye with the assistance of high-intensity light. The patient’s eyes might be dilated during this examination, so the patient might experience a little discomfort in the eye. In this test, the doctor places a machine in front of the patient on which the patient rest’s their forehead and chin on. The doctors might put eye drops in the patient’s eyes to make the problems in the cornea of the eye visible properly. This exam is also called biomicroscopy. The doctor will use a microscope of low power and a high-intensity light called a slit lamp. The doctor will then look at the patient’s eye care. The slit lamp also consists of many different filters to allow the doctor to look at the eye from different views. The doctors track changes in the eye in real time with devices that capture the image digitally.
The doctors may also perform the Tensilon test. The tension test requires the use of the drug called Tensilon (edrophonium). This drug helps the doctor diagnose myasthenia gravis in the patients. Tensilon prevents the breakdown of the neurotransmitter acetylcholine, it is the chemical which is released by the nerve cells to stimulate a person’s muscles. People who have the disease Myasthenia Gravis do not react normally to acetylcholine. Tensilon attacks the patient’s acetylcholine receptors, preventing muscles from getting tired easily and being stimulated. A person will be tested positive for myasthenia gravis if their muscles get stronger after the use of tensilon.
The treatment for ptosis depends on the cause for the problem and the severity of the problem. If the condition exists because of old age or because the person was born with it, then they might not receive a treatment for the drooping of their eyelids. The doctors say that the treatment is not required because it is not harmful to their health. However, they can get a plastic surgery if they want to decrease the drooping. If there are any underlying conditions that are the reasons for the drooping of the eye, the doctors will likely treat you for that. They make sure that it stops the sagging of eyelids.
If the patient’s eyelids block their vision, they will require medical treatment as it might cause other problems in the eyes related to vision. The doctors suggest surgery in many cases. If the drooping of the eyelids is just temporary then the doctor will suggest glasses that hold the patient’s eyelids up. Normal eyeglasses may also be suggested by the doctor if a surgery is not required.
The doctors might suggest surgery for ptosis. The levator muscle in the eyelids is tightened. This causes the eyelids to be lifted up. The levator muscle is that muscle which contracts to lift up a body part. The doctors might suggest a surgery for children with ptosis to avoid an onset of amblyopia or a lazy eye. However, there are many risks involved with the surgery such as scratching of the cornea of the eye, dry eye and hematoma. Hematoma is the clotting of blood. It is also not too uncommon for the surgeons to move the eyelids too high or too low.
The other surgery that is suggested by the doctors for the elevation of eyelids which can be performed is frontalis sling surgery. In this surgery, the eyelid is attached to the frontalis muscle in the forehead of the patient using a fascial sling or by using a sling made of synthetic material. By attaching the drooping eyelid to the frontalis muscle in the forehead to raise the eyelids, this procedure relieves the dysfunctional levator muscle from the task of lifting up the eyelids of the patient. This is the most common surgery used in cases of congenital ptosis and when the levator functions are very poor.
When the case of drooping of the eyelid is not severe or temporary, the doctors suggest other methods for fixing the problem such as wearing eyeglasses. A ptosis crutch is a non-surgical method which involves the eyeglasses. The ptosis crutch is an attachment made to the patient’s eyeglasses. The ptosis crutch holds the drooping eyelids in place. The ptosis crutch is of two types: adjustable and reinforced. Adjustable crutches are attached to just one side of the eyeglasses and reinforced crutches are attached to both the sides of the eyeglasses. Crutches can be attached to almost every type of glasses, but they are most suitable for metal frames. If a person is interested in getting ptosis crutch as an attachment, they should first consult a plastic surgeon or an ophthalmologist who work with people with drooping eyelids.
Drooping eyelids cannot be prevented as there are no ways to do so. Knowing the proper systems can be a really good start in actually avoiding the problem to some extent. Getting regular eye exams and check-ups can be of help in fighting the disorder. If a parent notices the symptoms in their children, they should take their kids to a doctor immediately, to get treated and to be monitored so that they don’t develop the early onsets of amblyopia or a lazy eye. Since the drooping of the eyelids can affect the vision of an individual, it should be taken seriously. An individual can stop it from spreading or getting worse by seeing a doctor as quickly as possible.
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