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Ptosis: An Overview at Beach Eye Medical Group, Huntington Beach, Orange County

Ptosis, drooping of the upper eyelid

Ptosis is a drooping of the upper eyelid and can be present in one or both eyes. The eyelid may droop only slightly or it may cover the pupil entirely, restricting and even blocking the normal field of vision. Ptosis can be present at birth (congenital) or occur later in life. In congenital ptosis, the upper eyelid creases may appear asymmetrical.

Signs and Symptoms

  • Upper eyelid is lower than it should be
  • Excess skin in upper eyelid
  • Excessive tearing or watery eyes
  • Obstruction of vision

Ptosis in Adults: Causes and Concerns

In adults, the most common cause of ptosis is the separation or stretching of the levator muscle tendon from the eyelid. The levator muscle is responsible for lifting the eyelid. This separation may be occur due to the natural aging process or it may be the result of a cataract surgery, another eye surgery or an injury.

Adult ptosis may also be related to a complication of other diseases–specifically those involving the levator muscle or its nerve supply, such as neurological and muscular diseases and, in rare cases, tumors of the eye socket. Some other medical conditions that are associated with a drooping eyelid include:

  • Diabetes
  • Stroke
  • Myasthenia gravis (an autoimmune disease)
  • Horner syndrome ( a rare condition that affects the facial nerves)
  • Cluster headaches

In most cases, ptosis is an age-related condition and does not pose a serious problem. However, any change in the eye should be monitored. A drooping eyelid should be promptly examined if one eyelid suddenly droops or closes, if the droopy eyelid is accompanied by double vision or pain, and/or if vision is impaired.

Congenital Ptosis in Children: Causes and Concerns

If a child is born with ptosis, it is called “congenital ptosis.” Congenital ptosis is often caused by poor development of the levator muscle. This condition usually does not improve on its own over time. With moderate to severe congenital ptosis, the child may need treatment to have his or her vision develop normally.

The most serious problem associated with childhood ptosis is amblyopia (lazy eye), which is poor vision in an eye that did not develop normal sight during early childhood. This can occur if the lid is drooping severely enough to interfere with the child’s vision. More frequently, amblyopia can develop because ptosis tends to lead to constant blurriness of visual images, causing astigmatism. Ptosis can also hide misaligned or crossed eyes, which can cause amblyopia. Children with ptosis may raise the eyebrows and tilt the head, an indication that vision is being compromised.

Although it is usually only a problem with adult drooping eyelid, a child born with ptosis may also have eye-movement abnormalities, muscular diseases, lid tumors, or other tumors, neurological disorders or refractive errors.

Diagnosis of Ptosis

Beach Eye Medical Group eye doctor in Huntington Beach, Orange County eye specialists diagnose ptosis by carefully examining the eyelids. If drooping only occurs on one eyelid, it is more obvious to detect during a physical examination. For a more precise evaluation, the doctor will take detailed measurements of the height of the eyelids and will assess the strength of the eyelid muscles.

Additional tests may be performed to determine the effects on vision, including a slit-lamp examination and a field of vision test. Because adult ptosis can be associated with illness and disease, it is important to rule out any serious underlying cause of the drooping eyelid. The doctor will review your full medical history and may order blood tests, specifically for diabetes and myasthenia gravis.

Treatment and Correction of Ptosis

The treatment for ptosis can vary, depending on the cause. In some instances, such in the case of tumors and injuries, ptosis may resolve itself once the underlying illness or condition is addressed. If there is a medical condition that requires management, medication will often be prescribed. Other medications may be recommended to ease symptoms and help the nerves function better.

If vision is sufficiently impaired or the patient is concerned about the appearance of the eyelid, surgery is usually performed.

The surgical process. A procedure called blepharoplasty can be performed to raise the eyelid. The surgery involves making small incision, lifting the underlying muscle and removing excess eyelid skin. More severe ptosis may require the reattachment and strengthening of the levator muscle.

Recovery and results. Immediately after surgery, you may find it difficult to completely close your eye, but this is only temporary. Lubricating eyedrops and ointment can be helpful during this period. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In some cases, more than one operation may be required.

Risks of surgery. Like any surgery, there are risks associated with ptosis surgery. Although uncommon, complications can occur such as infection, bleeding, and reduced vision. In very rare cases, full eyelid movement does not return.

At Beach Eye, we have an oculoplastics surgeon–an ophthalmologist who specialize in plastic and reconstructive surgery–on staff to help with the evaluation and management of the ptosis.

If you or your child has a drooping upper eyelid and would like to learn more about treatment, contact the doctors at Beach Eye Medical Group for an eye exam and consultation. We can determine the underlying cause of the ptosis and design the most appropriate treatment plan for your individual case.

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