droopy eyes causes, ptosis and surgery

What is Ptosis?

Ptosis is the abnormal drooping of the upper eyelid.  It can be more visible when the person is tired or have been awake past sleeping time.  When it is severe and untreated, it can lead to amblyopia or astigmatism.  It can interfere in the development of vision when it is not treated in children at a young age.

Normal Eye:

Droopy Eye:

What are the causes of having droopy eyes?

The muscles of the eyelids are not able to function properly.  Sometimes, one or both eyes are affected.  Droopy eyelids are more common to older people due to the deterioratin muscles of their eyelids.  However, a person can be born with ptosis, which is called congenital ptosis.

Congenital ptosis can be hereditary but the causes are still unknown.  It can also be caused by trauma to the eyelid muscles or occulomotor nerve damage.  It can be an indication that the person maybe suffering from diabetes, brain tumor, or myasthenia gravis.  Sometimes, toxin exposure can contribute in occurence of ptosis.

Congenital ptosis:

Ptosis can be classified as Pseudo ptosis, Aponeurotic ptosis, Neurogenic ptosis, Myogenic ptosis, Neurotoxic ptosis, Blepharophimosis ptosis syndrome or Mechanical ptosis.

What are the signs and symptoms of ptosis?

Symptoms may present an underlying condition causing the ptosis and it includes the following:

• Drooping eyelids (it can be a droopy left eye or a droopy right eye, or both)
• Inability to close eye completely without any difficulty
• Affected eye is misaligned or crossed
• Head tilting to lift the lid
• Eye fatigue
• Irritation
• Double vision

How are droopy eyes detected and diagnosed?

The first thing that a doctor will determine when examining a person with droopy eyelid is the underlying cause.  He will take the eyelid’s height and muscle strength.  He will also have to examine the eye movements and alignment.  For children, he may require additional vision tests.

When the ptosis is caused by a disease, diagnosing and treating the underlying cause will improve the ptosis.

Treatment

A crutch glasses or scleral contact lenses to lift the eyelids can be used as a non-surgical remedy.  Most of the time it will require droopy eyes surgery through the expertise of an ophthalmologist with plastic and reconstructive surgery specialization.  This is conducted by strengthening and tightening the levator muscles and raise the eyelid.  When there is weakness in the levator muscle, the eyebrows and the eyelids are lifted.  While it can be done to adults on an outpatient basis under local anesthesia, children needs to stay in the hospital for further monitoring.

Surgical procedures may include:

• Resection of the Levator. This is done for patients who have congenital ptosis.  The levator tendon is shortened until the desired lid level is acquired.  For those with severe ptosis, the skin in the anterior part is shortened.
• Resection of the Müller muscle.  This muscle is found at the inferior surface of the levator and between the aponeurosis and the conjunctiva.  It is thin and a little bit darker as seen during surgery.  This is resected to raise the eyelid at a desired level.
• Frontalis sling procedure. This is somewhat the same as teh levator tendon resection.

Bilateral droopy eyelids before and after surgery:-

Unilateral ptosis before and after surgery:-