Eyelid ptosis: types, symptoms, causes and treatment

Eyelid ptosis is a disorder that affects the eye, causing a drooping of the upper eyelid, which generates a whole series of visual and aesthetic problems in the person who suffers from it.

In this article we explain what eyelid ptosis is, how the different types are classified, what are the symptoms associated with this condition and the indicated treatment.

• Related article: "The 11 parts of the eye and their functions"

What is eyelid ptosis?

Eyelid ptosis, blepharoptosis or drooping eyelids, is a condition that causes the upper eyelid to droop. This situation prevents the person from being able to open the affected eye wide, causing fatigue and making vision difficult.

This pathology affects all ages, although it has a higher incidence in adults. When it occurs in children, called infantile eyelid ptosis, can cause amblyopia (also known as lazy eye) and, as a consequence, loss of visual acuity, because the eye does not receive the visual stimulation necessary to develop normal vision.

Under normal conditions and when looking straight ahead, the upper eyelid that covers the cornea measures approximately 2 mm.

Eyelid ptosis can cause partial or complete occlusion of the pupillary area, with the visual deficit that this entails.

Classification and types of ptosis

Eyelid ptosis has been classified interchangeably by different authors., taking into account factors such as the time of its appearance, the cause, the function of the levator muscle of the upper eyelid or the degree of eyelid drooping, among others.

The most common classification groups them into: myogenic, aponeurotic, neurogenic, mechanical and traumatic.

1. Myogenic ptosis

Congenital myogenic ptosis usually appears at birth with a clear hereditary component, specifically autosomal dominant type (the disorder can occur if the abnormal gene is inherited from only one parent) and is sometimes related to sex.

It can be congenital or acquired. Congenital can, in turn, be simple myogenic, and is the most common type in childhood, its cause being levator muscle dysgenesis. It manifests itself from birth and remains stable. Three out of four are unilateral (in only one eye), and those that are bilateral are usually asymmetrical.

2. Aponeurotic ptosis

Aponeurotic ptosis They are caused by an alteration of the aponeurosis (the conjunctiva membrane that covers the muscles), whether congenital or acquired, due to disinsertion, stretching or dehiscence (spontaneous opening) of the levator palpebrae muscle.

This type of ptosis is the most common and is usually caused by the aging of the eyelid tissues, which is why it is also called senile ptosis.

3. Neurogenic ptosis

Neurogenic ptosis occurs infrequently. They may be caused by aplasia (lack of development) of the nucleus of the third cranial nerve., due to peripheral, nuclear or supranuclear lesions.

Although this type of ptosis usually occurs in isolation, cases associated with other conditions have been described. neurological manifestations, such as: ophthalmoplegic migraine, which causes headache on one side of the head or around eye; Horner syndrome, which produces neurosympathetic paralysis and pupillary alterations; or Marcus-Gunn ptosis, in which ptosis occurs due to certain movements of the mouth or jaw.

• You may be interested: "Cranial nerves: the 12 nerves that leave the brain"

4. mechanical ptosis

Mechanical ptosis occurs when there is an increase in eyelid weight or volume. This type of paintings are complicated in the long run by disinsertion of the levator eyelid, causing aponeurotic ptosis.

This group of ptosis includes: eyelid edema of different causes; eyelid tumors; orbital tumors; dermatochalasis or excess skin on the upper eyelid; and cases of conjunctival scarring, in which there is a shortening of the conjunctival fornices that pulls on the eyelid.

5. Traumatic ptosis

Traumatic ptosis is caused by a trauma that affects the aponeurosis, the levator palpebrae superioris muscle, or the nerve itself. This type of ptosis usually appears more frequently in individuals over 18 years of age.

Traumatic impacts can be of various kinds, although in most cases they happen to caused by a penetrating injury to the levator muscle or by laceration or disinsertion of the aponeurosis.

Symptoms

The most obvious clinical sign of eyelid ptosis is a drooping eyelid. Depending on the severity of the eyelid drooping, people who suffer from this condition may experience vision difficulties. Patients sometimes need to tilt their head back to be able to see under the eyelid, or even have to raise their eyebrows repeatedly to try to lift the eyelids.

The degree of eyelid drooping is different for each person. To really know if someone has this disorder, it is suggested to compare a recent photo of the face with one that is 10 or 20 years old. If notable differences are observed in the eyelid skin, it is advisable to see a specialist.

Eyelid ptosis may have similarities to dermatochalasis, a group of connective tissue conditions which causes excess skin on the upper eyelid. This usually occurs as a result of the passage of time, as the skin loses elasticity and accumulates, causing a tired and aged eyelid appearance.

In summary, it can be said that The most common symptoms associated with eyelid ptosis are the following:

• Descent of the upper eyelid that partially or completely covers the eye.
• Reduction of the visual field depending on the occluded pupillary area.
• Need to tilt head back.
• In some cases, the person needs to lift the eyelid with their own finger.

Treatment

Treatment of ptosis usually requires surgical procedures. The goal of surgery is to repair the muscle that elevates the eyelid or, if it does not work and is completely immobile, use the forehead as an accessory mechanism, so that an anchor point can be found in the muscle located above the eyebrows to take advantage of its mobility.

This type of treatment, called blepharoplasty, is a non-invasive aesthetic intervention. which is performed on the upper eyelids. During the procedure, excess skin and fat found on the eyelids is removed, so that the patient can regain a normal appearance.

They are relatively quick interventions (between 45 minutes and 1 hour) that are performed with local anesthesia, have a short recovery period and do not require hospital admission.

This procedure is not free of contraindications, as it is not recommended for people with health problems that may increase the risk of the intervention. It is also not recommended for pregnant women or patients with dry eye problems, hypertensive, diabetic, with healing problems, active infections or who suffer retinal detachment.

Bibliographic references:

• Clauser, L., Tieghi, R. and Galie, M. (2006). Eyelid ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview. Journal of Craniofacial Surgery, 17(2), 246-254.
• Junceda J., Hernández L. (1996) Eyelid Ptosis: Fundamentals and surgical technique. Allergan Publishing
• Ortiz, S., Sánchez, B.F. (2009) Eyelid Ptosis. Annals d'Ophthalmology 17 (4) 203-213
• Manual of Diagnosis and Treatment in Ophthalmology. Medical Sciences Publishing House. Havana, 2009.