Ptosis

Ptosis is a drooping of the upper eyelid. Ptosis occurs when the muscles that raise the eyelid are not strong enough to do so properly. It can affect one eye or both eyes and is more common in the elderly. It can block normal vision.

Childhood ptosis can cause amblyopia or "lazy eye." All children should have regular eye exams by an ophthalmologist.

Congenital ptosis is often caused by poor development of the levator muscle that lifts the eyelid. Although it is usually an isolated problem, a child born with ptosis may also have eye-movement abnormalities, muscular diseases, lid tumors or other tumors, neurological disorders, or refractive errors. Congenital ptosis usually does not improve with time.

The most common cause of ptosis in adults is the separation or stretching of the levator muscle tendon from the eyelid. This process may occur as a result of aging, after cataract surgery or other eye surgery, or as a result of an injury.

Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as neurological and muscular diseases and, in rare cases, tumors of the eye socket.

The most obvious sign of ptosis is the drooping lid itself. Ptosis can affect one or both eyelids. It may be present at birth or occur later in life.

In congenital ptosis, the upper eyelid creases may be uneven with one another. The child with ptosis lifts the eyelids by raising his or her eyebrows. These head and facial maneuvers are signs that the child is trying to use both eyes to see. Abnormal head positions like this could cause serious neck problems.

A physical examination helps to determine the cause. Sometimes special tests may be done to evaluate suspected causes, such as myasthenia gravis

Surgery can treat ptosis by tightening the levator, or eyelid-lifting muscle. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached to or suspended from under the eyebrow so that the forehead muscles can do the lifting.

Although surgery usually improves the height of the lid, both eyelids may still not appear perfectly symmetrical. In some cases, more than one operation may be required. In rare cases, full eyelid movement does not return.

If amblyopia is present, treatment with patching, eyeglasses, or eye drops may also be necessary.