What is eyelid ptosis or blepharoptosis?
Ptosis refers to a โdroopyโ upper eyelid. This droopiness can become so heavy that it blocks your vision. This happens because the pupil (black spot in the middle of the eye) can be covered by the drooping eyelid. Ptosis is typically caused by weakening or stretching of the muscle (levator palpebrae superioris) responsible for holding the eyelid open. Ptosis can be caused by congenital or acquired defects in the muscle (or its tendon), which lifts the upper eyelid. It is also associated with lesions, which weigh the eyelid down, or certain neurological diseases. The most common reason for ptosis increasing age which causes stretching of the tendon and weakening of the levator palpebrae superioris muscle. Other conditions that present like ptosis are excess skin or fat in the upper eyelid or eyebrow drooping. These are distinct conditions with different causes, although they may also impact patientsโ ability to see.
What causes eyelid ptosis?
โThere are many causes of ptosis. It is important to be evaluated by a specialist to understand the exact cause:
Congenital. Patients born with ptosis are referred to as having โcongenital ptosisโ. This type of ptosis should be addressed urgently as it can cause very early vision problems such as amblyopia (commonly referred to as โlazy eyeโ).
Illness. There are certain classifications of illnesses that can cause ptosis including thyroid disease, myasthenia gravis, Hornerโs syndrome or nerve injury. These diseases can either weaken the nerves that provide function to the muscle or affect the muscle directly. It is important to be fully evaluated by a specialist that can rule out any underlying diseases.
Eyelid Lesions. Growths and tumors in the upper eyelid can โweigh downโ or load the eyelid causing obstruction of your vision.ย
Age. The most common cause is ptosis related to aging. Age related changes of the muscle and overlying skin can cause significant drooping of the eyelid that can impair your vision.
Prior Surgery. Surgery of the eye or orbital region may cause eyelid drooping.
How is eyelid ptosis diagnosed?
Patients may notice your upper eyelid dropping or asymmetry between how far the left and right upper eyelids cover the colored part of the eye, called the iris, in the mirror. Severe ptosis may cover the pupil, which is the black dot in the center of the iris, leading to loss of upper field of vision. Patients may also notice that they need to constantly lift their forehead to compensate for eyelid drooping, which may bring them to their doctor to get their forehead lines treated. Physical exam is important for diagnosis. Dr. Araslanova will measure the function of the levator palpebrae superioris muscle by getting you to open and close the eyes. Special drops that stimulate Muellerโs muscle could be used during your physical exam, to estimate the degree of correction via a minimally invasive approach.
How is ptosis treated?
Mild ptosis that does not affect your ability to see may not need treatment. Some patients may pursue treatment to improve symmetry. Patient may also choose to combine ptosis correction with blepharoplasty to improve overall appearance of the eyes.ย
Mild ptosis can be treated with a small amount of botulinum toxin (Botox, Xeomin, Dysport, Juveau, etc) injections. Botulinum toxin can weaken the eyelid closing muscle called orbicularis oculi muscle, which can temporarily improve eyelid asymmetry.ย Like all botulinum toxin treatments, the relief is temporary, and treatment would need to be repeated every 3-4 months. Some patients who are not ready to commit to surgical correction, may benefit from this treatment in order to improve eyelid symmetry.ย ย ย
Moderate to severe ptosis that affects vision usually needs to be corrected surgically, where the muscle that lifts the eyelid is tightened, advanced or reinforced. Surgery could be performed through natural eyelid crease or from the inside of the eyelid without external scars depending on the desired result and the cause of ptosis. Your surgical plan will depend on the severity of the ptosis as well as the cause. Surgery is designed to restore strength and tone to the levator muscle that supports the upper eyelid. Mild to moderate ptosis with good levator palpebrae superiorus function can be approached from the inside of the eyelid in a minimally invasive way.ย
Significant or congenital ptosis generally requires an incision in a natural skin crease similar to blepharoplasty surgery. Some patients require transfer of their forehead muscle called frontalis or various sling procedures to improve eye opening and symmetry. Dr. Araslanova can guide you through both medical and surgical options depending on the severity of eyelid ptosis.