Ptosis is the medical term for drooping eyelids. This is a condition that may affect one or both upper eyelids. Ptosis in children, and hence one that is present since birth, is called congenital ptosis. Drooping eyelids in children can impact their vision as they grow up and therefore it is imperative that they see a paediatric ophthalmologist.
In adults however, in most cases, a drooping eyelid is the results from aging of previously normal structures. This is an involutional ptosis, where the delicate eyelid tissues have lost their elasticity and strength. In general droopy eyelids occur when the edge of the eyelid margin (upper eyelid) drops from its usual position above the eye. When the edge of the eyelid drops too low and covers part of the pupil, it can obstruct the upper part of the vision. Sometimes it just looks lower especially if only one eyelid is affected, and is a cosmetic issue that needs addressing.
Ptosis – how it occurs
Typically, the levator muscle (lifting muscle) has a very fine tendon at the front, called the aponeurosis (a very delicate sheet of light fibrous tissue) which stretches with age and the eyelid height drops. The levator muscle’s delicate aponeurosis is attached to the eyelid and to a tendinous ring well behind the eye, and is responsible for lifting the eyelid. When it is over-stretched with age, inflammation, swelling, or repeated small trauma, the eyelid drops slighty. If unattended to surgically, it will worsen with time.
Drooping eyelids can sometimes develop following a cataract surgery or other eye surgeries. This is due to the fact that the manipulation of the eyelid during a procedure can cause the muscles that hold the eye open to weaken. Other medical causes of drooping eyelids include stroke, a myopathy and trauma which have an impact on the eyelid lifting muscles. Surgical correction of a drooping upper eyelid involves repairing the over stretched delicate eyelid lifting muscle and its very fine tendon (aponeurosis) and reattaching it more strongly to the tarsal plate in the eyelid so that it works more efficiently again. This surgery is done under local anaesthetic as a day case or out patient by an oculoplastic surgeon skilled in eyelid surgery and the post operative care.
However, before eyelid ptosis surgery can be done, a thorough eyelid examination with measurements and photographs is required as each patient is individual and requires just the surgery tailored to their specific eyelid problem. The surface of the eyes and general eye health is also checked to ensure that eyelid ptosis does not have a medical cause and to ensure there are no co-existing medical eye problems. The oculoplastic surgeon then explains what is panned with the surgery and what to expect after ptosis surgery.
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