Ptosis - Congenital Ptosis

Ptosis (occasionally called blepharoptosis ) is the paralysis of the muscles of the eyelid . It is commonly called droopy eyelids . A congenital or acquired disorder, ptosis is a drooping upper eyelid that remains lowered despite the patient's effort to raise it. The condition may be unilateral or bilateral, continuous or intermittent. Severe ptosis usually responds well to treatment; slight ptosis may require no treatment at all.

Causes

Ptosis can be present at birth (congenital ptosis), or develop due to aging, injury or an aftereffect of cataract or other eye surgery. This condition can also be caused by a problem with the muscles lifting the eyelid, called levators. Sometimes an individual's facial anatomy causes difficulties with the levator muscles. An eye tumor, neurological disorder or systemic disease like diabetes may result in drooping eyelids.

Signs and Symptoms

The symptoms are dependent on the underlying problem and may include:

• Drooping lid (may affect one or both eyes)
• Irritation
• Difficulty closing the eye completely
• Eye fatigue from straining to keep eye(s) open
• Children may tilt head backward in order to lift the lid
• Crossed or misaligned eye
• Double vision

Diagnostic tests

Measuring palpebral fissure widths and checking the range of eyelid movement help to determine the severity of ptosis.

Other tests are used to determine the underlying cause of the disorder. For instance, the glucose tolerance test may reveal diabetes mellitus. The edrophonium test can confirm myasthenia gravis (in the patient with acquired ptosis and no history of trauma). Ophthalmologic examination may disclose foreign bodies. Magnetic resonance imaging or digital subtraction angiography may reveal an aneurysm.

Treatment

Slight ptosis that doesn't produce deformity or vision loss requires no treatment. Severe ptosis that interferes with vision or disfigures appearance may require surgery to resection weak levator muscles. To correct congenital ptosis, the patient may undergo surgery at age 3 or 4 or earlier if ptosis is unilateral and if pupillary occlusion may cause amblyopia. An alternative to surgery may be special eyeglasses with an attached suspended crutch on the frame to elevate the eyelid.

Effective management also includes treatment of the underlying cause. For example, in myasthenia gravis, neostigmine may be prescribed to enhance innervation to the muscles.

Surgical correction can be done to improve the appearance of the eyelids in milder cases if the patient desires it, and may be necessary to correct interference with vision in more severe cases. In children with ptosis, surgical correction may be necessary to prevent amblyopia .

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