Ptosis is an abnormal drooping of the upper eyelid when your eyes are looking straight ahead. It is also called blepharoptosis. It happens when one or both of the muscles that lift the upper lid aren't working properly or have become loosened from their positions above the lid. You can be born with ptosis (congenital ptosis) or you may develop the condition (acquired ptosis). In both cases it can run in families. Generally, if a child is born with or develops a drooping eyelid before they are a year old, his or her condition is described as congenital.

Alternative Names of Ptosis are: Drooping Eyelids.

Complications of Ptosis

• In children, the most serious complication of ptosis is a lazy eye (amblyopia). A lazy eye is when you can't see properly through one of your eyes. This is because the developing brain ignores the image sent to it in favour of the image received from the better-seeing eye. A lazy eye can be reversed, for example by correcting the position of the lid. After the age of eight, the visual pathways have developed and it may be impossible to reverse any loss of vision in a lazy eye.
• Children can be more sensitive to the visible effects of a ptosis and the condition may lead to emotional problems.
• In both adults and children, ptosis can disrupt vision and making it difficult to carry out everyday activities such as reading, navigating stairs or driving. For some people, this may cause headaches, usually at the front of your head.

Causes of Ptosis

The causes of ptosis can be divided into those that you develop (acquired ptosis) and those that you are born with (congenital ptosis).

Acquired ptosis

Acquired ptosis is classified into the following types according to the cause.

• Involutional ptosis. This is the most common acquired ptosis and is usually caused by the tissues around the eyelid weakening, due to the normal ageing process. Involutional ptosis is also common after surgery to the eye and affects up to six in 100 people after they have had a cataract operation. Other causes include an injury to the eye or long-term use of contact lenses.
• Neurogenic ptosis. Neurogenic ptosis occurs when the nerve supply to muscles in the eyelid becomes interrupted causing the eyelid to drop. This can be caused by conditions such as third nerve palsy or Horner's syndrome.
• Myopathic ptosis. This is caused by conditions that affect muscle in the body, such as myasthenia gravis and other less common conditions such as myotonic dystrophy.
• Mechanical ptosis. This is when a growth, lump or swelling causes the eyelid to droop. This may be due to a tumour or inflammation after having eye surgery.
• Pseudoptosis. This is when you appear to have a ptosis but it is in fact caused by another part of your eye not the eyelid muscles. For example, brow ptosis, when the eyebrow droops rather than the eyelid, or dermatochalsis, when excess skin on your upper eyelid hangs down rather than your eyelid muscles not working properly.
• Injury/trauma. Trauma to your eyelid may result in damage to the muscles and nerves supplying the lid. Damage to the bones surrounding the eye or chronic eye disease may occasionally cause the space behind the lid to not fill properly and give the appearance of a ptosis.

Congenital ptosis

For half the children born with ptosis, there is no obvious cause for their condition. Usually, the cause is attributed to a failure of the lid muscle to develop properly. However, it can be due to:

• other developmental conditions, such as blepharophimosis syndrome
• conditions affecting the nerves around the face and eyelids, such as third nerve palsy
• birth trauma
• muscular conditions, for example myasthenia gravis and rarer inherited muscle diseases
• pseudoptosis

Signs & Symptoms of Ptosis

• Drooping of one or both eyelids
• Increased tearing
• If ptosis is severe, interference with vision.

Diagnosis of Ptosis

• If you suspect you might have a ptosis, your GP or optometrist will be refer you to an ophthalmologist for further investigation and treatment. An optometrist is a healthcare professional who examines eyes, tests sight and dispenses glasses and contact lenses.
• If you are diagnosed with ptosis, you will be referred to an ophthalmologist for treatment. An ophthalmologist is a doctor who identifies and treats conditions affecting the eyes, including surgical treatments.
• The ophthalmologist will examine both your eyes thoroughly and carry out several tests to try to establish what is causing your eyelid to droop. He or she will also take measurements of your eyelids and compare them to normal eyelid measurements, as well as take photographs of your eyelids.
• Children with ptosis need to have their eyesight tested to see if they have developed a lazy eye.
• You may be referred to other healthcare professionals for additional tests and treatment if your ptosis is found to be caused by an underlying health condition.

Treatments of Ptosis

• Mild ptosis may not need any treatment other than regular monitoring. For congenital ptosis, this will include frequent eye checks to ensure that a lazy eye doesn't develop.
• However, depending on the cause, most people need an operation to treat ptosis. Surgery is usually carried out as a day case under local anaesthesia. This completely blocks feeling from the eye area and you stay awake during the operation. For children, general anaesthesia is used. This means that your child will be asleep during the operation.
• The most commonly performed operation involves making a small incision in the natural skin crease on your upper eyelid (making the cut in line with the skin crease tends to hide any scar). The muscles that open your eyelid are identified and tightened using stitches. The small incision on your eyelid is then closed up.
• You will have a pad over your eye for the first 24 to 48 hours after your operation. You will need to use antibiotic drops or ointment for one to three weeks after surgery.
• Sometimes, rather than having surgery, you can get special glasses with a crutch attached above the lens that hold up your drooping eyelid.
• If your ptosis is caused by an underlying health condition, you will need treatment for it as well.

Prevention of Ptosis

Good control of diabetes and high blood pressure can prevent some cases of a drooping upper eyelid. Lung cancer is a fairly uncommon cause of a drooping eyelid. This disease can usually be prevented by not smoking. Many cases cannot be prevented.

When to seek Medical Advice

• Drooping eyelids in children require prompt evaluation by an ophthalmologist.
• New or rapidly changing ptosis in adults requires prompt evaluation by an ophthalmologist.