Treatment and Complications of Ptosis | Ophthalmology

Ptosis

What is ptosis?

Ptosis is also called droopy eyelid when the eyelid muscle (levator palpebrae superioris muscle) becomes weak for various reasons. The most common cause in children is the underdevelopment of the levator palpebrae superioris. It is congenital and is called congenital ptosis. Less common, then the muscles weaken. It involves one or both of the upper eyelids at different levels, with or without symmetry.

Ptosis affects one or both eyes. Sometimes it is an isolated problem that replaces a person’s appearance without changing vision or health. However, in other cases, it is a warning sign that a more serious condition may affect the muscles, nerves, brain, or eye socket. Ptosis that develops over days or hours indicates a serious medical problem.

Who gets ptosis?

Ptosis can occur at any age, but it is more common in adults. An eyelid can drop onto the pupil and interfere with vision. Patients often report that their vision improves by manually lifting the eyelid margin with their fingers. When an eyelid affects vision, it can be repaired. In adults, the most common cause of eyelids or ptosis is a tear of a muscular ligament in the eyelid.

Children can be born with ptosis or develop it at a young age, giving them uneven or low eyelids. In some cases, visual development is impaired due to ptosis in children. An eye exam is needed early on when a child has congenital ptosis. Children with congenital ptosis should be monitored and care should be evaluated in the first years of life. If vision is not affected, congenital ptosis repair is usually planned for 3-5 years.

Symptoms

The most obvious sign in a person is a drooping eyelid. It can happen at any time and the drop is visually noticeable. People born with ptosis have irregular shapes or wrinkles on the eyelids. However, some of the symptoms that accompany the droopy eye are:

  • Block normal vision
  • Eyes will be either watery or dry
  • Fatigue
  • Stress
  • Migraine

Types

Congenital ptosis: The levator muscle does not develop properly in utero, so the baby is born with compromised or low levator function. As a result, babies born with ptosis often have limited upper-field focus (this is the top of their field of vision) and may tilt their head back to try to see correctly.

Acquired ptosis: It can exist in several forms.

  • Mechanical ptosis: It occurs when the eyelid is overwhelmed by excess skin or tissue.
  • Aponeurotic ptosis: It occurs when the lavender muscle of the eyelid is stretched. It is usually caused by the aging process, but it can also be caused by rubbing your eyes excessively or pulling the eyelid.
  • Neurogenic ptosis: It is caused by a problem in the nerve pathways that control the movement of the eyelid muscles. These problems involve horner syndrome, third nerve palsy, and myasthenia gravis.
  • Traumatic ptosis: It occurs when the eyelid is injured or the levator muscle is affected.

Causes

Ptosis occurs when the levator palpebrae superioris muscle does not contract properly. This also happens when the upper torso muscle does not contract properly. Several conditions can cause this. For example, ptosis can be caused by:

  • Structural problems with the muscle that is being from birth
  • Muscle diseases(such as mitochondrial myopathy or myotonic dystrophy)
  • Rare disorders being from birth (such as congenital orbital fibrosis)
  • Problems with the tendon attached to the superior tarsal muscle
  • Senescence, dehiscence, or disinsertion of the levator aponeurosis
  • Too much pressure on the eyelid (such as from an eyelid tumor)
  • Injury (especially during eye surgery)
  • Nerve problems (such as with the third cranial nerve or in Horner syndrome)
  • Connection problems between the muscle and the nerve (such as in myasthenia gravis)

Risk factors

Potential risk factors for ptosis include:

  • Age
  • Contact lenses
  • Excessive eye rubbing
  • Eye surgery
  • Horner’s syndrome
  • Myasthenia gravis

Diagnosis

For some, all the doctor has to do is perform a physical exam. The decrease in these cases is obvious, so no further diagnostic tests are required. However, if the doctor suspects that the disease is the cause, more tests are needed.

During the evaluation, the doctor can take pictures of the person to be able to compare them and determine if the treatment is successful in the future or the progression of ptosis.

If an additional eye exam is required, a wedge lamp exam may be considered. The doctor usually paints the eyes and can also use other use lotion to disperse the students. The doctor may perform this test to examine various structures of the eye, including the conjunctiva, eyelids, lens, cornea, iris, and sclera.

Loss of peripheral vision occurs with different brain and eye defects. Visual field tests are a way to measure peripheral vision. In most cases, the doctor will cover one eye per person. With another eye, they focus on something in front of them. Then the doctor asks what they see at the edges of their visual field.

The tensilon test may be considered if myasthenia gravis is a suspected cause of ptosis. For this test, the person is given a tensilon pill. If this drug strengthens a person’s muscles, they will have a positive- stress test.

Treatment

Treatment includes surgery and various procedures. The goal is to lift the lid to fit the other side with minimal scarring and side effects. The excess inability to close the eye completely after surgery is a much-debated topic. This creates a dry eye condition that is difficult to maintain.

In the age-related form, the dysfunctional eye is much less visible after the first eye has been successfully repaired. To look at this fallen look in the eye doesn’t work. It may also require surgery.

Surgery: Ptosis surgery is done under local anesthesia with sedation (the patient is awake but not feeling the procedure). The types of surgery to repair a droopy eyelid are as follows:

  • The surgeon makes an opening in the skin of the upper eyelid. This allows the surgeon to find the small muscles that lift the eyelid. The surgeon sutures to tighten this muscle and lift the eyelid. More stitches are made in the skin of the eyelid after the incision.
  • The surgeon can perform the entire surgery from under the eyelid. In this case, the eyelid is turned and squeezed from under the muscle. This procedure does not require an incision in the skin.

After surgery, your doctor will explain how to care for your eye. It is important that the patient returns to the doctor after surgery so that the results can be verified.

Appointments are generally scheduled for several days to a week after surgery.

Sometimes the eyelid may still shrink a little or the eyelid may not close completely. If the doctor notices this, further treatment may be recommended. However, in general, the eyelid is in good condition immediately after the operation.

Complications

Bleeding and infection, which are potential risks with any surgery, are very rare. Be sure to tell your surgeon if you have low blood pressure. Small bruises or swelling should be expected that disappear in a week or two. Some patients experience dry eyes after surgery. This can make contact lens wear uncomfortable or require over-the-counter tears for comfort.

Your surgeon may not be able to control all the variables that determine the final location of your eyelid. There is always the possibility that the cap is more or less than desired or that the curve and shape of the cap are different. Touch-up surgery may be necessary to improve the position of the eyelid. While the perfect symmetry between the two lids is never guaranteed, most patients will see an improvement in the condition of their lids and will be happy with the results. As with any medical method, there may be other natural risks that should be discussed with your surgeon.

Prevention

There is no way to prevent droopy eyelids. Knowing the symptoms and getting regular eye exams can help fight the disorder. If your child seems to have droopy eyelids, take them to a doctor right away for treatment and monitoring. Since ptosis affects your vision, you need to take it seriously. You can prevent it from getting worse by seeing a doctor right away.

Prognosis

Droopy eyelid is stable, intensifies over time (progressive), or may come and go (intermittently). The result of treatment depends on the cause of the ptosis. In most cases, surgery is very strong in curing appearance and function. In children, more stained eyelids can lead to laziness or amblyopia. This can lead to long-term vision loss.

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