Ptosis Definition, Reason, Symptoms, Treatment & Prevention
Definition
Ptosis or blepharoptosis is a term used to describe a drooping of the upper eyelid, either slightly or to cover the pupil area.
These conditions can limit or even interfere with normal vision.
Ptosis can be found at birth ( congenital ) or later ( acquired ).
Congenital ptosis can be caused by a problem with the muscle that is responsible for lifting the eyelids.
Meanwhile, acquired ptosis can be caused by aging, eye injuries, side effects after eye surgery, and in rare cases due to tumors.
Ptosis
| Medical specialist | Eye Specialist |
| Symptoms | Lowering of the upper eyelid |
| Risk Factors | Old age, disorders of the nerves and muscles around the upper eyelid |
| Diagnosis | History, physical examination, supporting examination |
| Treatment | Based on the main cause |
| Drug | Based on the main cause |
| Complications | Impaired vision, amblyopia |
| When to See a Doctor? | If the lowering of the eyelids covers the pupil so that it interferes with the function of vision |
Symptoms
Symptoms and signs of ptosis that can generally be recognized include:
- The eyelids appear drooping, often presented as sleepy-looking eyes
- Can cause visual disturbances, when the eyelids are lowered so much that they cover the vision
- The folds on the upper eyelids appear asymmetrical
- In congenital ptosis, children often try to tilt their head up, lift their chin, or raise their eyebrows in an effort to see more clearly.
- This habit can cause head and neck problems, for example aches or pains.
- Can be accompanied by eye movement abnormalities.
Reason
Congenital ptosis and acquired ptosis have different causes.
Ptosis from birth is often caused by abnormal development of the levator palpebra superior muscle, which functions to raise the upper eyelid.
Meanwhile, acquired ptosis has many possible causes. However, this condition is often caused by problems with the nerves and/or eye muscles.
For example, myasthenia gravis, progressive external ophthalmoplegia, Horner’s syndrome, and problems with cranial nerve III (which innervates the levator palpebra superior muscle).
In addition, other causes of ptosis are the aging process or trauma to the eye. This condition can cause separation of the levator palpebra superior muscle from the eyelids, which can lead to ptosis.
Risk Factors
Some risk factors that can trigger eye ptosis include:
- Age
- Habit of excessive eye rubbing
- Eye surgery
- Horner’s Syndrome
- Myasthenia gravis
Diagnosis
A thorough evaluation is necessary to establish the diagnosis of ptosis, as well as the possible causes, which consist of:
1. Anamnesis (medical interview)
At this stage, the doctor will ask about the signs and symptoms you are experiencing, a history of ptosis (duration, factors that aggravate or relieve symptoms, etc.), past medical history.
In addition, the doctor will also ask about whether there is a family history of ptosis.
2. Physical examination
A complete eye examination, especially focused on examining eyelid position, visual function, refractive examination, and head position.
3. Supporting examination
At this stage, to find out the cause of ptosis.
For example, imaging the brain, eye, and cerebrovascular system if ptosis is accompanied by other neurological deficits, or testing serum antibodies to acetylcholine receptors if myasthenia gravis is suspected.
Treatment
Ptosis does not always have to be treated with surgery. If the cause of ptosis is known, treatment can often vary because it will be adjusted to the cause.
Basically, if the cause can be handled properly, ptosis complaints can be cured.
For example, if it is caused by myasthenia gravis, the symptoms of ptosis will be treated by a neurologist (not an ophthalmologist). And, appropriate treatment for myasthenia gravis can improve ptosis symptoms.
Often, ptosis symptoms are corrected surgically. There are various surgical techniques that can be performed to improve ptosis symptoms, for example:
1. Frontalis Sling
The frontalis sling is performed to “hang” the upper eyelid from the frontalis muscle.
2. Levator Advancement
Levator advancement is a shortening procedure of the levator palpebra muscle.
3. Fasanella Saves Ptosis Procedure
Fasanella Servat ptosis procedure is a shortening procedure of several parts of the eye (conjunctiva, tarsus, and Mueller’s muscle).
4. Mueller Muscle Conjunctival Resection
Mueller muscle conjunctival resection is a shortening of some parts of the eye (conjunctiva and Mueller’s muscles).
5. Full Thickness Resection
Full-thickness resection is a shortening of the eyelids.
However, in some cases, sufferers do not want surgery.
If so, it can be suggested that people with ptosis use special glasses with a holder that functions to hold the upper eyelid so that it does not droop.
Prevention
It is difficult to prevent ptosis, especially if it is congenital. In addition, some of the causes of acquired ptosis are also often not preventable. For example, due to natural aging.
However, avoiding the use of contact lenses and reducing the habit of excessive eye rubbing can reduce the risk of ptosis.
Prevention of ptosis due to certain diseases can be adjusted to the main cause of lowering of the upper eyelid.
Complications
Ptosis in children needs to be corrected properly so as not to cause complications in visual function. For example, the appearance of amblyopia or lazy eyes and astigmatism.
Ptosis can also cause aesthetic problems, which can cause a child to lose self-confidence, withdraw from social situations and affect academic performance.
In adults, untreated ptosis often causes visual disturbances and frontal headaches.
Impaired vision can cause problems in carrying out daily functions. For example driving, reading, climbing stairs, and so on.
When to See a Doctor?
When lowering the upper eyelid has blocked the pupil, causing visual disturbances, you should consult further with an ophthalmologist.