Ptosis
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What is Ptosis?
The understanding about ptosis is that it refers to the drooping of the upper eyelid, which can affect vision and cosmesis. Ptosis can be congenital or acquired and may have various causes, including neurogenic, myogenic, aponeurotic, mechanical, or traumatic factors.
Proper evaluation and diagnosis are crucial for prompt management. Treatment options include surgical or medical interventions tailored to the specific cause of ptosis to improve patient outcomes.
Coordination among interprofessional team members is essential for effective management and improved patient outcomes.
Symptoms
Treatments
Precautions
Symptoms
Ptosis symptoms include
- Visual Disturbance: Patients commonly present with varying degrees of visual disturbance, which can range from mild to severe. This can occur in one or both eyes and is often accompanied by cosmetic disfigurement.
- Other Associated Problems: Depending on the underlying cause, ptosis may be associated with additional symptoms such as diurnal variability, diplopia (double vision), eyeball deviation, or body fatigability.
- Age of Onset and Duration: Differentiating between congenital and acquired cases is important, which can be determined by the age of onset and duration of symptoms.
- Diurnal Variability: Some patients may experience changes in the severity of ptosis throughout the day.
- History of Trauma or Surgery: Inquiring about any previous history of trauma, surgery, or medical treatment is essential for understanding the underlying cause of ptosis.
Early identification and treatment are vital to prevent long-term complications.
Treatments
- Levator Resection: Shortening the levator muscle through various approaches like Everbusch, Blaskovics, Fasanella-Servat, Motais, or Hess’s procedure, depending on the degree of ptosis and muscle function.
- Frontalis Brow Suspension: Tethering the eyelid to the frontalis muscle using fascia tunica or synthetic materials, indicated for severe ptosis with poor levator function, especially in congenital cases.
- Aponeurotic Strengthening: Advancement of the aponeurosis, primarily for aponeurotic disinsertion or involutional ptosis.
- Taping Upper Lid Open: Used in myogenic and some neurogenic ptosis cases.
- Spectacle Props (Eyelid Crutches): Eyelid crutches attached to glasses, providing support for the eyelid.
Precautions
- Evaluate age of onset and associated symptoms.
- Inquire about trauma, surgery, or medical history.
- Check for upper lid margin covering more than 2 mm of the cornea.
- Observe both eyes for compensatory changes.
- Look for abnormalities near the eyelids.
- Assess pupillary function and ocular motility.
- Perform tests like the jaw-winking sign.
- Perform phenylephrine test for surgery candidacy.
- Use edrophonium or ice test for Myasthenia gravis.
Types of Ptosis
Before Surgery
During the Surgery
After the Surgery
Before Surgery
- Evaluation: Assess the type, severity, and underlying cause of ptosis to determine the appropriate surgical approach.
- Counseling: Educate the patient about ptosis, treatment options, and potential complications, setting realistic expectations
- Coordination: Collaborate with a multidisciplinary team to prepare the patient, assist during surgery, and provide postoperative care.
- Testing: Conduct necessary diagnostic tests to evaluate the patient’s suitability for surgery and identify any underlying conditions.
- Surgical Approach: Select the most suitable surgical technique based on the preoperative assessment and patient’s goals.
- Patient Preparation: Provide instructions for preoperative care, including medication adjustments and dietary restrictions, to ensure readiness for surgery.
During the Surgery
- Assess the patient’s condition thoroughly to choose the appropriate surgical method based on ptosis type and severity.
- Educate the patient about ptosis causes, treatment options, and potential outcomes.
- Collaborate with a team of specialists for comprehensive care.
- Select the surgical technique based on preoperative evaluation, including levator resection, Motais procedure, etc.
- Consider nonsurgical options like taping or using spectacle props for certain types of ptosis.
After the Surgery
- Postoperative Care: Give detailed instructions for wound care, medication, and activity restrictions.
- Monitoring: Schedule follow-up appointments to track recovery and detect complications early.
- Patient Education: Continue educating about recovery, symptoms, and complications, fostering open communication
- Rehabilitation: Provide guidance on exercises for muscle function and eyelid movement.
- Collaboration: Maintain close communication with the healthcare team for comprehensive care.
Ptosis FAQs
When should I talk to my doctor about ptosis?
If you experience droopy eyelids affecting one or both eyes, schedule an appointment with an optometrist or ophthalmologist. Your eye doctor can help you find out what is causing your condition and whether any additional testing is needed.
Who is the best doctor to repair ptosis?
Ptosis should always be repaired by an oculoplastic surgeon trained in this procedure. The eyelid anatomy is complex. Ptosis surgery requires years of training and expertise to perfect. It is important that your surgeon has many years of experience performing surgical ptosis repair.
Is ptosis serious?
In some situations, ptosis can have a serious underlying cause. But ptosis can also be harmless, mild and may even go away on its own. If you think you have ptosis, it’s important to rule out anything serious with the help of an eye doctor.
In some cases, ptosis can be a sign that someone is having a stroke. If you or someone you know is experiencing any of the signs or symptoms of stroke, seek emergency medical attention immediately.
Can ptosis occur at any age?
Yes. Since ptosis can be a symptom of an underlying disease, it can occur at any age.
Can droopy eyelids go away on their own?
Yes, some cases of ptosis can go away on their own. They can also return without warning. This cycle of coming and going can sometimes repeat indefinitely.
However, many forms of ptosis will not go away on their own. In these cases, medical treatment of the underlying condition or ptosis itself will be necessary.
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