Spokane Eye Clinic, PTOSIS

Ptosis (pronounced TOE-sis) is a Greek word meaning downward displacement. In medical terms, it refers to a drooping upper eyelid. A person with ptosis cannot lift one or both of their eyelids all the way, usually because of a malformed eyelid-lifting muscle. The affected eyelid may droop only slightly, or it may droop enough to partially or completely cover the pupil, restricting or obscuring vision.

Ptosis may be inherited, be present at birth, or occur later in life. When ptosis is mild, treatment may be desired for cosmetic reasons, but is not medically necessary. When ptosis is severe enough to obstruct vision, it may result in a condition called amblyopia and treatment is usually beneficial.

Congenital Ptosis
Ptosis present at birth is called congenital ptosis. Congenital ptosis is often caused by poor development of the eyelid lifting muscle, called the levator. Although usually occurring as an isolated problem, children born with ptosis may also have eye movement abnormalities, muscular diseases, lid tumors, or neurological disorders. Congenital ptosis usually does not improve with time.

When an infant is born with moderate or severe ptosis, treatment is necessary to allow normal visual development and prevent amblyopia. Amblyopia (also called lazy eye) is a condition in which one eye does not develop good vision. This condition is usually caused by strabismus, where the brain basically shuts off one of the misaligned eyes to avoid double vision. If the weak eye is not used in early development, vision in that eye will often be permanently damaged or possibly lost. Amblyopia may occur in a child with ptosis if the lid is drooping severely enough to block vision or if there is associated astigmatism. Ptosis can also hide a misalignment or crossing of the eyes that can itself cause amblyopia.

A drooping upper eyelid is the primary sign of ptosis. Children with ptosis will often tip their heads back into a chin-up posture to see underneath their eyelids or raise their eyebrows in an effort to raise their lids.

Finally, ptosis may negatively affect a child’s appearance.

Treatment
The treatment for ptosis is surgery, although there are a few rare disorders that may be treated non-surgically with medications. In determining whether surgery is advisable, an ophthalmologist considers the individual’s age, the severity of the ptosis, and whether one or both eyelids are involved. Measurement of the eyelid height, evaluation of the eyelid’s lifting and closing muscle strength, and observation of the eyes’ movements aid the doctor in determining what surgical procedure is best.

During surgery the levators are tightened. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from the brow so that the forehead muscles do the lifting.

Any child with ptosis, whether they have surgery or not, should be examined on a yearly basis by an ophthalmologist for amblyopia, refractive errors, and other associated conditions. Even after surgery, focusing problems may develop as the eyes grow and change.

Adult Ptosis
The most common type of adult ptosis is caused by the separation of the levator muscle tendon from the tarsal plate (a structure within the eyelid). This can occur as a result of aging, after cataract or other eye surgery, or from an injury. Adult ptosis may also occur as a complication of other diseases, such as diabetes, involving the levator muscle or its nerve supply. Or, it may occur when movement of the levator muscle is restricted, as may happen in the case of an eyelid tumor.

The most obvious sign of adult ptosis is a drooping upper eyelid. There may be some vision loss in the upper field of vision or fatigue and headaches from attempting to elevate the drooping lid. In a similar fashion to children with ptosis, adults with ptosis will often tip their heads back to see past their eyelids or raise their eyebrows in an effort to raise their lids.

Treatment of Adult Ptosis
Your ophthalmologist may use blood tests, X-rays or other diagnostic tests to determine the cause of the ptosis and plan the best treatment. Treatment, when necessary, is usually surgical. When the levator has separated from the tarsal plate, reattachment of the muscle can correct the ptosis. Sometimes a small tuck in the lifting muscle and eyelid can lift the lid sufficiently. More severe ptosis requires greater tightening of the levator muscle.

Before embarking on a surgical treatment, be aware that as with any surgery, ptosis surgery has risks involved, including infection, bleeding, and reduced vision. These complications occur very infrequently. A temporary inability to fully close the eye after ptosis surgery is not uncommon. Lubricant drops and ointments are usually helpful in this situation. It is also important to know that although improvement of the lid height is usually achieved, perfect symmetry in the height of the two eyelids and full eyelid movement is sometimes not achieved.