What is Ptosis?
Ptosis comes from the Greek word ptosis meaning to fall. Drooping of the eyelids can occur on the upper and lower eyelids. If the drooping of the upper eyelid is present at birth or before age six or seven, it needs to be repaired or the child will develop lazy eye or amblyopia.
What is the Etiology for Ptosis?
The muscles that raise and lower the eyelids become weak and are unable to perform their function. These muscles are the levator and M?ller’s muscle. There are numerous etiologies for ptosis and include:
- Congenital Ptosis
There are certain rare syndromes associated with congenital ptosis but most causes for congenital ptosis are not known.
The eyelids muscles are weakened from such diseases as myasthenia gravis, blepharophimosis, hereditary or muscular dystrophies.
There is a loss of nerve supply to the eyelid muscles from third nerve palsy secondary to diabetes mellitus, stroke, trauma to the nerve, Horner’s syndrome, or Marcus Gunn Jaw Winking Syndrome.
Trauma to the eyelid such as a laceration through the eyelid and muscles can result in ptosis. Severe enough trauma to cause damage to the third nerve innervating the muscles can also result in ptosis.
The levator tendon or aponeurosis (layers of flat broad tendons) attaches to the tarsus or cartilage in the eyelid to be able to pull on the eyelid. In many cases of ptosis, the aponeurosis loses its attachment to the tarsus most commonly following eye surgery. During eye surgeries the eye is held open by a lid speculum, this stretching of the eyelids can cause the aponeurosis to lose its connection to the tarsus. Long term use of contact lenses can lead to aponeurotic ptosis.
Common Specific Diseases that Cause Ptosis
Ptosis Secondary to Myasthenia Gravis
Ptosis of the upper eyelid or lids is commonly the presenting symptom for myasthenia gravis. The degree of ptosis varies and usually progresses through the day from muscle fatigue. Ptosis from myasthenia gravis can be diagnosed by a Tensilon test and blood tests. It is typically treated with Mestinon oral medication which improves the muscle function.
Third Nerve Palsy Ptosis
There are two types of third nerve palsy that can cause ptosis of the eyelids. The two types are dilated-pupil third nerve palsy and pupil-sparing third nerve palsy. Dilated-pupil third nerve palsy is usually caused by compression or damage to the third nerve from a brain aneurysm or tumor. This obviously needs immediate diagnosis and possible intervention. Pupil-sparing third nerve palsy is commonly associated with diabetes mellitus and is usually temporary. It lasts from a few weeks to three or four months.
Horner’s Syndrome Ptosis
Horner’s Syndrome is characterized by mild ptosis, miosis (smaller pupil), and anhidrosis (dry skin). This is caused by damage to the sympathetic nerve that supplies innervation to Muller’s muscle, portion of the muscles that dilate the pupil, and sweat glands around the orbital area.
Ptosis After Eye Surgery
The speculum used to hold the eye open during surgery can cause stretching of the levator aponeurosis. The eyelid has a typical appearance as the aponeurosis loses its attachment to the eyelid and it slowly retracts backwards. It drags some of the upper eyelid skin upward with it and the eyelid slowly begins to droop.
Treatment of Ptosis
Non-Surgical Treatments of Ptosis
Treatment of the ptosis depends on the etiology, severity of the ptosis, and upper or lower eyelid. A medical type of ptosis may be treated with medication such as with myasthenia gravis. Non-surgical approaches can be crutch eyeglasses that have a bar or arm that extends from the frame to pull up the upper eyelid.
Surgical Treatments of Ptosis
The type of surgery will depend on the severity of the ptosis. The common surgical approaches are:
- Locating and reattaching the aponeurosis back to the tarsal plate
- Resecting or shortening the levator muscle
- Attaching a frontalis sling to hold up the eyelid
If you have drooping of the upper or lower eyelid, there are many causes. You need to see an eye doctor to diagnosis the etiology of the ptosis so that proper treatment can be done. If you have a sudden onset of ptosis you need to see evaluation immediately as a third nerve palsy could be secondary to a aneurysm.