Ptosis Treatment in Delhi, India

There are two types of ptosis

1. Congenital ptosis: If the individual has this condition by birth, it is called congenital ptosis. Because the levator muscle does not develop properly in the womb, the kid is born with limited or no levator muscle function. As a result, children with ptosis frequently have restricted superior field vision (the top part of the field of vision) and may tilt their heads back to see correctly.

If these children are not treated, they may develop other vision abnormalities, such as amblyopia or lazy eye. When a child’s vision is still growing and has total vision in one eye but only partial in the other because of ptosis, the neural routes from the brain to the damaged eye might atrophy or waste away. As a result, that eye develops a lazy eye or has undeveloped vision.

Because untreated congenital ptosis might impair the child’s vision, physicians may recommend surgical treatment at a young age to avoid complications.

2. Acquired ptosis: The patient gained the disease later in life. Acquired ptosis can manifest itself in five different ways during a person’s life.

• Aponeurotic ptosis: It is the most prevalent type of acquired ptosis. The levator muscle of the eyelid becomes overstretched in this disease, mainly caused by age and post-op complications. Excessive eye rubbing or eyelid pulling because of eye irritation or long-term contact lens use can also contribute to the illness.

• Neurogenic ptosis: It develops when there is a problem with the neural system that governs eyelid muscle action. Myasthenia gravis, third nerve palsy, and Horner syndrome all show neurogenic ptosis as a symptom.

• Myogenic Ptosis: It is caused by levator muscle myopathy or defect at its neuromuscular junction. Ocular myopathy and various types of muscular dystrophy are examples of these disorders.

• Mechanical Ptosis: Excess skin or abnormal external structure weighs down the eyelid. It can include a neoplasm, chalazion, contact lens in the upper fornix, etc.

• Traumatic Ptosis: Traumatic ptosis is caused by an injury to the eyelid, which can occur because of an accident or other type of eye trauma. The levator muscle is compromised or weakened because of this injury.

Ptosis is characterised by the drooping of one or both upper eyelids. It can affect the patient’s vision sometimes. Some people report that their eyelids drooping is barely perceptible or does not always occur.

• The patients may also notice that their face appears tired or weary.
• Patients with severe ptosis may have to tilt their heads back to see at all times. They have to do this every time they speak or have a conversation with someone.
• If the patient report other symptoms such as migraine and headaches, it is possible that there are other underlying causes.

• Routine exam: The doctor will perform a physical exam and check the patient’s medical records. They will ask the patient some questions like how often eyelids droop and how long this has been happening, etc.

Doctors will run some tests, which may include:

• Slit-lamp exam: The doctor will perform a slit lamp exam to rule out any other associated condition leading to ptosis. He also examines the quality of tears.

• Levator muscle Function: This is done by pressing the thumb firmly against the patient’s brow while looking down. This gives an idea about the lifting capacity of the eyelid.

• Measuring margin Crease Distance (MCD): MCD is the distance from the lid margin to the skinfold of the upper lid. It is higher in aponeurotic ptosis, whereas absent in congenital ptosis.

• Tensilon Test: Tensilon, a medication, may be injected into one vein by the doctor. The patient may be requested to cross and uncross their legs multiple times, as well as rise and sit down.

The doctor will monitor the patient to see if the Tensilon improves the drooping. This will assist them in determining whether the droopy eyelid is caused by a disorder known as myasthenia gravis.

The treatment for droopy eyes or ptosis depends on its cause and severity. If the ptosis results from age or it is something the patient was born with, the doctor may suggest observing only. However, the patient can opt for surgery to correct the condition.

If, during the diagnosis, the doctor finds out an underlying disease that has been causing ptosis, they may suggest treatment for that condition. This will eventually stop eyelids from sagging.

If eyelids affect the patient’s vision, the doctor may suggest special glasses for people with ptosis. They are called ptosis crutch. The crutch prevents drooling by holding the eyelid in place. This treatment is effectively temporary. But a patient who does not qualify for surgery can use them too. Crutches can be installed in any glass and work best with metal frames. It is hardly used nowadays.

Severe ptosis, which blocks the vision, will require ptosis surgery. The levator muscle is strengthened during this operation. It raises the eyelid into the desired position. Doctors occasionally propose surgery for children with ptosis to prevent the formation of lazy eyes or amblyopia.

Early complications of ptosis surgery:

• The height and shape of eyelids may differ from each other.
• Rarely, there may be a loss of some eyelid movement.
• Under correction or overcorrection, which may resolve with time
• Surgical site infection
• Bleeding from the wound
• Exposure keratopathy

Poorly executed surgery resulting in an undesirable appearance or dry eyes from lifted eyelids not closing completely

Complications that take a while to happen:

• Postoperative mild lagophthalmos
• Late complication
• Persistent lagophthalmos
• Exposure keratopathy
• Recurrent ptosis is a chronic complication of ptosis repair surgery
• Persistent under correction or overcorrection requires revision surgery

Risk factors of droopy eyelid or ptosis include:

Ptosis can be a side effect of other medical conditions that can weaken the levator muscles. Especially if both eyes are drooping.

• Eye surgery such as Lasik can cause ptosis
• Age
• Contact lenses
• Excessive eye rubbing
• Eye surgery
• Horner’s Syndrome
• Myasthenia Gravis
• Injury of eyelid muscles or ligaments
• Damage to the nerve controlling the eyelid muscles
• Ageing
• Complications of eye surgery
• Genetic defect
• Accidental stretching or tearing of the levator muscle
• Neoplasm, chalazion, scarring, etc., can weigh down eyelids
• Ocular myopathy, Marcus Gunn Jaw-winking syndrome, multiple sclerosis, and many other diseases can cause ptosis

The kind and treatment of ptosis influence the prognosis. The proper surgical procedure, done by an excellent surgeon based on the preoperative evaluation, results in a favourable prognosis.

Proper preoperative evaluation and postoperative treatment with close monitoring increase the result of surgical correction in any type of ptosis.

Reviewed by Dr. Rituraj Baruah, Senior Consultant, Eye Care / Ophthalmology on 16-Dec-2022.