Ptosis

Ptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes.

The ptosis may be mild - in which the lid partially covers the pupil; or severe - in which the lid completely covers the pupil.

Ptosis can occur at any age. When present since birth it is called congenital ptosis. When present in the elderly it is called acquired ptosis.

While the cause of congenital ptosis is often unclear, the most common reason is improper development of the levator muscle. The levator muscle is the major muscle responsible for elevating the upper eyelid. In adults ptosis is generally due to weakening / dehiscence of the levator muscle. It may also occur following injury to the muscle as after lid injuries and eye surgeries. Rarely it may be due to myasthenia gravis ( a condition where there is progressive weakness of muscles).

Children with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows in an effort to see from under their drooping eyelid. Children with congenital ptosis may also have amblyopia ("lazy eye"), strabismus or squint (eyes that are not properly aligned or straight), refractive errors, astigmatism, or blurred vision. In addition, drooping of the eyelid may result in an undesired facial appearance and difficult social life. In moderate ptosis there is a loss of the upper field of vision by the drooping upper lid.

Ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. If the ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age (the "pre-school" years). However, when the ptosis interferes with the child's vision, surgery is performed at an earlier age to allow proper visual development. Ptosis repair is usually completed under general anesthesia in infants and young children and under local anesthesia in adults.