Ptosis - Causes, Symptoms, Diagnosis & Treatment
Ptosis, or blepharoptosis, is a condition in which the upper eyelid(s) droop uncontrollably. The disorder can be unilateral (affecting one eye) or bilateral (affecting both). The severity of the droop can range from a minor nuisance, to a life-changing disease that significantly hinders vision in the affected eye(s). Although ptosis usually occurs in adults due to age-related degeneration, it is also seen in children, as it can be acquired congenitally.
Causes of Ptosis
There are two main types of ptosis – Congenital and Aponeurotic (age-related or senile ptosis). In congenital ptosis the baby is born with an underdeveloped levator muscle, which controls the movements of the upper eyelid. In more than two thirds of cases congenital ptosis only affects one eye. If the individual was not born with ptosis, it is likely that the condition is caused by the effects of aging. As years pass the tendons that control the levator muscle have a tendency to stretch and become weaker. Age-related ptosis usually affects both eyes, however one eye typically droops more than the other.
Ptosis can also be one of the first appearing symptoms of myasthenia gravis, a disease that affects communication between muscles and nerves. This disease gradually causes an increased weakness in muscular systems throughout the body, starting with facial muscles. Sometimes congenital ptosis can be attributed to an inherited muscle disease known as oculopharyngeal muscular dystrophy, which causes difficulty blinking and swallowing. Another type of muscular disease called progressive external opthalmoplegia can cause the onset of ptosis in young adults.
Any occurrence that damages the nervous system (i.e. – the aftermath of an aneurysm, stroke, brain tumor, diabetes-related nerve damage etc.) can cause ptosis. A less common cause of ptosis is Horner's syndrome, which causes the pupil of the affected eye to become extremely small, and causes loss of the ability to sweat on the affected side of the face. Rarely, a tumor or infection in or around the eyelid or eye socket can cause ptosis. If the eye is struck hard enough, extreme swelling can occur that is often classified as temporary impact-induced ptosis.
Symptoms
The primary symptom of ptosis is a drooping eyelid, which makes the condition very easy to diagnose in most cases. However, minor cases can be significantly less noticeable. As a general rule of thumb, the eyelid should never be covering any part of your pupil; if it is, you have some degree of ptosis. A drooping eyelid can cause a plethora of unpleasant secondary symptoms that can reduce your quality of life. First, if the condition is affecting vision the patient may try to compensate by raising their eyebrows in an attempt to lift their eyelid above their pupil. Doing this repeatedly has been known to cause tension headaches. Eventually, the actions you take to compensate for your impaired vision (i.e. – holding your head back and looking down past your nose, or using your eyebrows to lift your eyelids) will cause your appearance to become somewhat unsettling to others, and this could have a detrimental effect on your social life.
Diagnosis
Although a drooping eyelid in itself is easy to spot, diagnosing the cause may be a bit more difficult. After conducting a basic visual examination, your doctor will probably order imaging tests like a CT scan or MRI to determine the root of the problem. Depending on the results of the imaging tests, the doctor may take blood work and perform an injection of Tensilon (edrophonium chloride) to rule out the possibility of myasthenia gravis; if you have myosthenia gravis the injection will temporarily relieve symptoms. Finally, a muscle biopsy may be performed, in which a piece of the affected eyelid is removed and examined in the laboratory under a microscope to rule out cancer.
Treatment and Prognosis
If ptosis is blocking the field of vision or is significantly affecting the patient's appearance, the only effective treatment would be using plastic surgery to surgically raise the eyelid. The procedure usually requires local anesthesia, as this allows the patient's eyelids to remain open during the surgery, making it easier for the surgeon to adjust the eyelid position while they are open.
In congenital ptosis, most doctors will recommend immediate corrective surgery, as treating the condition early in life will reduce the possibility of vision development problems. However, if the child has a more minor form of ptosis that is not impairing their vision, the doctor may recommend waiting a few years before performing the surgery. In childhood ptosis surgeries, general anesthesia is used to prevent the possibility of unnecessary traumatization.
If a muscular or nerve-related disease is causing ptosis, treating this condition with the appropriate medication may lessen the extent to which the eyelid droops. Unless ptosis is treated at an early age, or can be treated as a symptom of another disease, it is usually an ongoing problem that the patient must learn to adjust to.
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