Ptosis is an eye condition that is characterized by droopy eyelids. This condition may be present from birth (congenital ptosis) or may develop with age or due to other factors such as physical trauma or other medical conditions (acquired ptosis). If the condition affects just one eye, it is known as unilateral ptosis and if it affects both the eyes, then it is referred to as bilateral ptosis. The condition is equally likely to afflict both men and women.
While mild ptosis only has aesthetic implications, more severe or degenerative ptosis can block the pupils of the eye and impair vision. Such a condition could require surgery to halt or even reverse the drooping of the eyelids.
What are the different types of Ptosis?
There are six recognized types of ptosis which includes the following:
- Neurogenic Ptosis occurs as a result of an imbalance in the nerve pathways that control the movement of the eyelids. This can be a result of third nerve palsy, Horner syndrome or myasthenia gravis which is a long-term neuromuscular disease that leads to a weakening of many muscles, including the eyelid muscles.
- Mechanical Ptosis is likely to occur if the eyelid is weighed down by a mass of excessive skin. A few common causes are edema, inflammation, tumors.
- Traumatic Ptosis can occur due to an external injury or trauma to the eyelid or eye which can result when the eyes are left unprotected while playing sports, going out in the sun, or working with tools.
- Myogenic Ptosis can be caused due to certain types of systematic disorders that cause muscle weakness (eg. muscular dystrophy, a genetic disorder that causes progressive muscle degeneration) which can weaken the levator muscle.
- Aponeurotic Ptosis is perhaps the most common type of ptosis which occurs as a result of aging and is therefore also known as “Senile Ptosis”. In this condition, the levator muscle becomes overstretched and loses its elasticity. Prolonged contact lens use or excessive rubbing of eyes can also be a cause for this kind of ptosis.
- Congenital Ptosis is a condition where a child is born with the ptosis. This occurs due to the lack of proper development of levator muscles while the child is in the womb. If not treated properly, it can result in a lifetime of poor vision and appearance of a lazy eye. Surgery may often be recommended to fix it. It is therefore recommended that routine checkups are carried out to ensure that such conditions do not occur and even if they do, they are treated at the earliest to prevent any risks in future.
How do you know if you have Ptosis?
Following are some common signs and symptoms of ptosis:
- Sagging eyelids that cover most of the eye
- A tired look in the eyes
- A dull, mild aching in and around the eye area
- Dryness of the eyes
- Excessive watering of the eyes
- The need to tilt your head backwards or lift your chin up or the need to raise your eyebrows to look ahead clearly
- Migraine headaches that coincide with a noticeable increase in the droopiness of the eyelids.
Causes of Ptosis
While the most common cause of ptosis is age-related muscle degeneration, following are other common root causes of ptosis:
- Weakening of nerves and muscles
- Myasthenia gravis
- Lung cancer
- Horner’s Syndrome
- Some kind of injury or trauma to the eye or eyelid
- Cataract surgery
- Brain or eye tumor
- Cancer of the nerves
Treatment of Ptosis
The exact treatment of the ptosis will vary on the kind of ptosis that you suffer from and the severity of the condition. A plastic surgery known as a Blepharoplasty may be considered to reverse the drooping of the eyelid if it has become severe and is interfering with vision.
The two common treatments of ptosis include surgery and ptosis crutch.
The ptosis crutch is a bar that is attached to the inside of the frame of eye glasses or spectacles that help to prop up droopy eyelids. Prior to designing the crutch, a measurement is taken of the eyelid and surrounding structures so as to allow for a “custom-built” or tailored crutch that fits perfectly. The two types of crutches include adjustable and reinforced.
Adjustable crutches: these are attached to one side of the eye glass frames, usually closer to the nasal bridge and are adjustable however they are often rendered loose due to the constant need to adjust them which weakens the metal.
Reinforced crutches: these are attached on both ends of the eye glass or spectacle frames. Unlike adjustable crutches, these crutches are only slightly adjustable and more resistant to breakage.
Ptosis crutches may cost somewhere around $70-$100.
Ptosis correction surgery
The doctor may recommend surgery depending on the severity of the condition. Prior to the surgery, the surgeon must assess the condition of the eye and develop a surgical plan.
The surgery aims to lift the levator muscle by tightening it. The surgery is usually carried out using a local anesthetic and takes around 45 minutes to one 1 hour. The eyelid and surrounding areas are treated with local anesthesia and then a small incision is made on the eyelid. The tendon-like structures at either end of the levator muscle are then shortened and reattached to increase tension and, consequently, to raise the eyelid back up to the appropriate level.
The risks of ptosis correction surgery are minimal but include the following :
- Scratched cornea
- Dry eye
- Unusual bruising and stiffness around the eye area
- Asymmetric eyelids (it is recommended that incase both the eyes suffer from ptosis, that both eyes be operated on at the same time so that symmetry is maintained).
The cost of ptosis surgery is around $2,300-$3000 depending on whether just one lid or both eyelids are operated upon.
Can Ptosis be avoided?
It is difficult to avoid age-related ptosis. However, ptosis that is induced by trauma, excessive rubbing of the eyes or prolonged rigid contact lends usage can be prevented by taking the appropriate protective, lifestyle and behavioral measures.
Regular check-ups are advisable as they can help detect ptosis at an early stage so that remedial action can be taken before the condition starts to impair vision.