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Ptosis refers to a “droopy” upper eyelid. This droopiness can become so heavy that it blocks your vision. This happens because the pupil (black spot in the middle of the eye) can be covered by the drooping eyelid. Ptosis is typically caused by weakening or stretching of the muscle (levator palpebrae superioris) responsible for holding the eyelid open. Ptosis can be caused by congenital or acquired defects in the muscle (or its tendon), which lifts the upper eyelid. It is also associated with lesions, which weigh the eyelid down, or certain neurological diseases. The most common reason for ptosis increasing age which causes stretching of the tendon and weakening of the levator palpebrae superioris muscle. Other conditions that present like ptosis are excess skin or fat in the upper eyelid or eyebrow drooping. These are distinct conditions with different causes, although they may also impact your eye’s ability to see.
There is a small muscle in the eyelid, levator palpebrae superioris (LPS) muscles that is responsible for opening the eye and lifting the eyelid. Its decreased function leads to the eyelash margin falling downward to cover the pupil of the eye, eventually blocking vision. It can affect one or both eyes. Some patients can develop compensatory strategies such as lifting of the forehead or straining to raise the eyelids. Continued compensatory strategies could lead to premature horizonal forehead lines, eye strain and tension headaches. In severe cases, patients tilt head back or lift eyelids with fingers or tape in order to see properly.
There are many causes of ptosis. It is important to be evaluated by a specialist to understand the exact cause:
Congenital. Patients born with ptosis are referred to as having “congenital ptosis”. This type of ptosis should be addressed urgently as it can cause very early vision problems such as amblyopia (commonly referred to as “lazy eye”).
Illness. There are certain classifications of illnesses that can cause ptosis including thyroid disease, myasthenia gravis, Horner’s syndrome or nerve injury. These diseases can either weaken the nerves that provide function to the muscle or affect the muscle directly. It is important to be fully evaluated by a specialist that can rule out any underlying diseases.
Eyelid Lesions. Growths and tumors in the upper eyelid can “weigh down” or load the eyelid causing obstruction of your vision.
Age. The most common cause is ptosis related to aging. Age related changes of the muscle and overlying skin can cause significant drooping of the eyelid that can impair your vision.
Prior Surgery. Surgery of the eye or orbital region may cause eyelid drooping.
You may notice your upper eyelid dropping or asymmetry between how far the left and right upper eyelids cover the colored part of the eye, called the iris, in the mirror. Severe ptosis may cover the pupil, which is the black dot in the center of the iris, leading to loss of upper field of vision. Patients may notice that they need to constantly lift their forehead to compensate for eyelid drooping, which may bring them to their doctor to get their forehead lines treated. Physical exam is important for diagnosis. Your doctor will measure the function of the levator palpebrae superioris (LSP) muscle by getting you to open and close the eyes. Your doctor will also rule out systemic illnesses that could imitate blepharoptosis. Special drops that stimulate Mueller’s muscle could be used during your physical exam, to estimate the degree of correction via a minimally invasive approach.
Mild ptosis that does not affect your ability to see may not need treatment. Some patients may pursue treatment to improve symmetry. Patient may also choose to combine ptosis correction with blepharoplasty to improve overall appearance of the eyes. Moderate to severe ptosis that affects vision usually needs to be corrected surgically, where the muscle that lifts the eyelid is tightened, advanced or reinforced. Surgery could be performed through natural eyelid crease or from the inside of the eyelid without external scars depending on the desired result and the cause of ptosis.
Your surgical plan will depend on the severity of the ptosis as well as the cause. Surgery is designed to restore strength and tone to the levator muscle that supports the upper eyelid. Mild to moderate ptosis with good levator palpebrae superiorus (LSP) function can be approached from the inside of the eyelid in a minimally invasive way.
Significant or congenital ptosis generally requires an incision in a natural skin crease similar to blepharoplasty surgery. Some patients require transfer of their forehead muscle called frontalis or various sling procedures to improve eye opening and symmetry. Your doctor will guide you through the process if you are a surgical candidate for correction.
The Surgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of blepharoptosis. Dr. Araslanova can provide the optimal treatment for ptosis. Moderate to severe ptosis causing symptoms may be covered by your insurance although most insurances consider milder ptosis that doesn’t block vision to be cosmetic. Photographs and visual field-testing showing eyelid position and visual obstruction are necessary for coverage. If the degree of ptosis is not severe enough to affect your vision, it could still be corrected as a cosmetic procedure to improve symmetry. As out-of-network physicians, we will check your benefits for you and let you know if there are costs are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us.