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Ptosis: Treatment, symptoms, advice and help

About ptosis

Ptosis refers to abnormal drooping of the upper eyelid which can affect one or both the eyes. It may be constant or intermittent in nature. Ptosis can be congenital, if present since birth or it may be acquired when it develops later in life. Usually ptosis occurs as an isolated disorder but may also be associated with various other conditions.

Ptosis: Incidence, age and sex

Ptosis is an uncommon condition in the general population and it may afflict both children and the adult population. Incidence of ptosis is more in older adults, probably due to the aging factor. Both men and women are equally susceptible to ptosis.

Signs and symptoms of ptosis: Diagnosis

The most common feature of ptosis is drooping of the upper eyelid of the affected eye. Depending on the severity of drooping, it is categorized into: minimal (1-2 mm), moderate (3-4mm) and severe (> 4mm). Individual with ptosis may complain of increased tearing and blurred vision. Patients with significant ptosis may need to lift the eyelid with finger, or raise their eyebrows for normal straight vision and this may lead to tension headache and eyestrain.

Complete physical examination is needed to investigate any associated causes. Smear and culture of exudates along with slit lamp and tonometry examination may be helpful in the diagnosis. Certain investigations may be advised to detect any suspected underlying cause.

Causes and prevention of ptosis

Ptosis usually results due to failure of eyelid muscles to function properly. This may occur due to localized damage to eyelid muscles or damage to nerve supplying the eyelid muscles. It may also occur as a normal aging process. Individuals with diseases like Myasthenia gravis, Diabetes mellitus, stroke, Horner’s syndrome and brain tumour are at increased risk of acquiring ptosis. In fact myasthenia gravis which is a neuromuscular disorder is one of the common causes of acquired ptosis.

Ptosis: Complications

If left untreated, especially in children, ptosis may lead to a complication called ‘Lazy Eye’ where the child cannot see properly with one of his or her eye. This condition can be reversed if treated properly. There may be emotional disturbances in children due to visual defect and physical disfigurement.

Ptosis: Treatment

Regular monitoring of the condition is required in cases of mild ptosis, where no visual impairment is present. However, significant congenital ptosis may warrant surgical intervention which includes expertise of an eye specialist and a plastic surgeon. Surgical modalities include correction of eyelid muscles and procedures like Levator resection, Muller muscle resection or Frontalis sling operation are generally performed. Non-surgical modalities like use of Crunch glasses or special Scleral contact lenses are also popular nowadays. Moreover, it is important to evaluate and subsequently treat the underlying cause of ptosis. The prognosis of this disorder is good and resolves completely especially after surgical management.