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"Ptosis" is the medical term for a drooping upper eyelid. Eyelid drooping can sometimes affect your vision if it’s severe. Ptosis isn’t a disease. It’s actually a symptom of a condition that you should seek treatment for.
A number of factors that affect the muscles, nerves, or skin of the eyelids can cause ptosis. The muscles that allow your eyelids to move up and down are called the levator muscles. They can weaken from age or injury. In addition, some people may be born with eye muscles that are weaker than normal, causing them to develop ptosis at a young age.
Nerve damage can contribute to ptosis as well. A common cause of ptosis is Horner’s syndrome. Horner’s syndrome is a form of nerve damage that occurs in the face and eyes. It’s usually the result of an underlying condition. Stroke and other brain injuries, spinal cord injuries, and some forms of lung cancer can cause Horner’s syndrome and ptosis.
Some chronic conditions, including diabetes and myasthenia gravis, may also increase your risk of ptosis. Diabetes is an inability to process sugar correctly. It can lead to a number of complications, including eye disease. Myasthenia gravis is an autoimmune disease that affects the way your muscles and nerves communicate.
Cluster headaches can also cause ptosis in some people. Cluster headaches are severe headaches that strike frequently during "cluster periods" and then go into remission.
The primary symptom of ptosis is a visible drooping of the upper eyelid. Ptosis can affect children and adults at any stage of life. You may notice symptoms in one or both eyes. People who are born with drooping eyelids have congenital ptosis. One of the signs of congenital ptosis is having uneven or absent creases in the eyelids.
Children who have ptosis may use certain gestures or body positions common to people with this symptom. Frequent eyebrow raising and head tilting can indicate that ptosis is interfering with normal sight.
The American Academy of Ophthalmology stresses the importance of eye exams for children and adults with ptosis. A vision test that uses an eye chart can help determine if eyelid drooping is compromising your or your child’s vision.
Blood tests used to detect diabetes and autoimmune conditions can help diagnose the underlying cause of ptosis. Your doctor may also perform X-rays to see if structural abnormalities around the eye are causing the problem.
Treatment for ptosis varies. If diabetes is the cause, your doctor will teach you how to manage this condition. Drooping eyelids caused by any of the following may resolve after your doctor addresses the underlying condition:
If myasthenia gravis is the cause, you doctor will likely prescribe medication to ease ptosis and other symptoms of this disease. Medications, such as neostigmine and pyridostigmine, may help your muscles and nerves work together more effectively. Your doctor may also prescribe prednisone or other immunosuppressant drugs.
In cases of congenital ptosis, the levator muscles usually don’t improve on their own. They may require surgery. Surgical repair involves manually tightening the levator muscles to lift the eyelid. You may have trouble opening and closing your eye immediately after surgery, but as you recover, this function will return. An eyelid lift can restore normal vision in many cases.
Children who have ptosis are at an increased risk for developing a lazy eye. Lazy eye, called amblyopia, is the blurring or absence of vision in one eye. Amblyopia occurs when you have impaired nerve connections between your brain and eye.
One treatment for this condition involves putting a patch over your normal eye to make your lazy eye work more efficiently. Surgical repair of ptosis can help prevent lazy eye.
The underlying cause of ptosis plays a major role in determining the outlook for people with this condition. Surgery can be very successful in restoring vision, eye function, and the appearance of the eye.
The American Academy of Ophthalmology reports that making a small tuck in the lifting muscle and removing excess skin can make a big difference in appearance. In more severe cases, the levator muscle may need strengthening and reattachment. In some cases, however, even after surgery your eyelids may not look entirely symmetrical.
Surgery carries the risk of:
Therefore, surgery is indicated only in cases of disabling ptosis.
Written by: Erica Roth
Medically reviewed on: Mar 10, 2016: University of Illinois-Chicago, College of Medicine
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