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Ptosis Disease - Symptoms, Causes, Treatment

Definition of Ptosis

Ptosis Disease - Symptoms, Causes, Treatment. Ptosis, or blepharoptosis, is a term used to describe a condition in which the upper eyelid droops, either slightly or to cover the pupillary area. This condition can limit or even hinder normal vision.

Ptosis Disease - Symptoms, Causes, Treatment

Ptosis can be found at birth (congenital) or later (acquired). Acquired ptosis itself can be found in various age ranges, but generally occurs in elderly people.

Causes of Ptosis

Congenital and acquired ptosis have different causes. Ptosis that is present at birth is often caused by a developmental abnormality of the levator palpebrae superior muscle, which functions to elevate the upper eyelid.

Acquired ptosis has many possible causes, but is often caused by problems with the nerves and/or muscles in the eye. Examples include myasthenia gravis, progressive external ophthalmoplegia, Horner's syndrome, and problems with cranial nerve III (which supplies the levator palpebra superior muscle). Aging or trauma to the eye can also cause stretching or separation of the levator palpebral superior muscle from the eyelid, potentially leading to ptosis.

Ptosis Diagnosis

A thorough evaluation is necessary to establish the diagnosis of ptosis, as well as the possible causes, which include:

  • History: signs and symptoms experienced, history of ptosis (duration, factors that aggravate or relieve symptoms, etc.), history of previous illnesses, family history of ptosis, and so on.

  • Physical examination: complete eye examination, mainly focused on examining the eyelid position, visual function, examination of refraction, and head position.

  • Investigations: usually aim to find out the cause of ptosis. For example, imaging studies of the brain, eyes, and cerebrovascular system if ptosis is accompanied by other neurologic deficits or examination of serum antibodies to acetylcholine receptors if myasthenia gravis is suspected.

Symptoms of Ptosis

Symptoms and signs of ptosis that can generally be recognized include:

  • The eyelids appear drooping, often complained of as the eyes appear sleepy.

  • Can cause vision problems, if the eyelids are so lowered that they cover vision.

  • The folds of the upper eyelid appear asymmetrical.

  • In congenital ptosis, children often try to tilt their head up, lift their chin, or raise their eyebrows in an attempt to see more clearly. This habit can cause head and neck problems, such as aches or pains.

  • May be accompanied by abnormalities of eye movement.

Ptosis Treatment

If the cause of ptosis is known, then often the treatment can be different because it will be adjusted to the cause. 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 the symptoms of ptosis.

Often, the symptoms of ptosis are corrected by surgery. There are various surgical techniques that can be performed to improve the symptoms of ptosis, for example:

frontal sling

Frontalis sling is performed to 'hang' the upper eyelid from the frontalis muscle

Levator advancement

Levator advancement is a shortening procedure of the levator palpebrae muscle

Fasanella Servat ptosis procedure

Fasanella Servat ptosis procedure is a shortening procedure of several parts of the eye (conjunctiva, tarsus, Mueller muscle).

Mueller muscle conjunctival resection

Mueller muscle conjunctival resection is shortening of some parts of the eye (conjunctiva and Mueller muscle)

Full thickness resection

Full thickness resection is a shortening of the eyelid

In some cases, patients do not want surgery. If this is the case, it can be recommended that people with ptosis use special glasses with retainers that function to hold the upper eyelid from dropping.

Ptosis in children needs to be corrected properly so as not to cause complications in visual function. For example, the emergence of amblyopia or lazy eyes and astigmatism. Ptosis can also cause aesthetic problems, which can cause a child to lose self-confidence, withdraw from relationships and affect academic performance.

In adults, untreated ptosis often causes visual disturbances and frontal headache. Impaired vision can cause problems in performing daily functions. For example driving, reading, climbing stairs, and so on.

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