PTOSIS in Children and Adults

Ptosis is a Greek word meaning downward displacement.  In Ophthalmology, it refers to a drooping upper eyelid.  The lid may droop only slightly or it may droop enough to partially or completely cover the pupil, restricting or obscuring vision.

 

Ptosis may be inherited.  It can affect one or both eyelids, be present at birth, or occur later in life.  Ptosis which is present at birth is called congenital ptosis.

 

When an infant is born with moderate to severe ptosis, treatment is necessary to allow normal visual development.  If the ptosis is not corrected, a condition called amblyopia ("lazy eye") may develop.  If untreated, amblyopia can lead to permanent suppression of sight in one eye.

When ptosis is mild, treatment may be desired for cosmetic reasons but is not medically necessary.  When ptosis is severe enough to obstruct vision, treatment is usually beneficial.

 

Congenital Ptosis

 

What causes congenital ptosis?

Ptosis which is present at birth is often caused by poor development of the eyelid-lifting muscle, called the levator.  Although usually occurring as an isolated problem, children born with ptosis may also have eye movement abnormalities, muscular diseases, lid tumors or neurological disorders.  Congenital ptosis usually does not improve with time.

 

What are the signs and symptoms of congenital ptosis?

 

A drooping upper eyelid is the primary sign of ptosis.  Children with ptosis will often tip their heads back into a chin-up posture to see underneath their eyelids, or raise their eyebrows in an effort to raise their lids.

 

What problems can occur as a result of childhood ptosis?

 

The most serious problem associated with childhood ptosis is amblyopia.  Amblyopia is poor vision in an eye that failed to develop normal sight in the early years of life.  This may occur in a child with ptosis if the lid is drooping severely enough to block vision or cause astigmatism.  Ptosis can also hide a misalignment or crossing of the eyes which can itself cause amblyopia.  If not treated early in childhood, amblyopia persists throughout life.

 

Other problems which can occur as a consequence of uncorrected childhood ptosis include astigmatism and blurred vision.  Ptosis may negatively affect a child's appearance.

 

How is congenital ptosis treated?

 

The treatment for ptosis is surgery, although there are a few rare disorders that may be treated non-surgically with medications.  In determining whether surgery is advisable, an ophthalmologist considers the individual's age, the severity of the ptosis, and whether one or both eyelids are involved.  Measurement of the eyelid height, evaluation of the eyelid's lifting and closing muscle strength, and observation of the eyes' movements aid your ophthalmologist in determining what surgical procedure is most appropriate.

 

During surgery the levators, the eyelid lifting muscles, are tightened.  In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from the brow so that the forehead muscles do the lifting.

 

Severe congenital ptosis may require prompt surgery to avoid amblyopia and to allow proper visual development.  Mild or moderate ptosis in children usually does not require surgery early in life, but does require periodic eye exams to monitor visual development and check for refractive errors which may need correcting with glasses.  Surgery can be performed at any age for cosmetic reasons.

 

Any child with ptosis, whether they have had surgery or not, should be examined annually by an ophthalmologist for amblyopia, refractive errors and other associated conditions.  Even after surgery, focusing problems may develop as the eyes grow and change shape.

 

Adult Ptosis

 

What causes adult ptosis?

The most common type of adult ptosis is caused by the separation of the levator muscle tendon from the lid.  This can occur as a result of aging, after cataract or other eye surgery, or from an injury.  Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes.  Or, it may occur when movement of the levator muscle is restricted as may happen in the case of an eyelid tumor.  An adult with untreated childhood ptosis will still have the condition as an adult.

 

What are the signs and symptoms of adult ptosis?

 

The most obvious sign is a drooping upper eyelid.  There may be some vision loss in the upper field of vision or fatigue from attempting to elevate the drooping lid.  Adults with ptosis will often tip their heads back to see past their eyelids, or raise their eyebrows in an effort to raise their lids.

 

How is adult Ptosis treated?

 

An ophthalmologist may use blood tests, X-rays or other tests to determine the cause of the ptosis and plan the best treatment.  Treatment, when necessary, is usually surgical.  When the levator tendon has separated from the lid, reattachment of the muscle can correct the ptosis.  Sometimes a small tuck in the lifting muscle and eyelid can lift the lid sufficiently.  More severe ptosis requires greater tightening of the levator muscle.

 

Dr. Bogart can provide a comprehensive assessment of your ptosis, a discussion of the available treatment methods, and information about possible risk complications.

 

What are the risks of ptosis surgery?

 

The risks of ptosis surgery include infection, bleeding and reduced vision but these complications occur very infrequently.  A temporary inability to fully close the eye after ptosis surgery is not uncommon.  Lubricant drops and ointments are frequently useful in this situation.  It is also important to know that although improvement of the lid height is usually achieved, perfect symmetry in the height of the two eyelids and full eyelid movement is sometimes not achieved.

 

Ptosis in both children and adults can be successfully treated with surgery to improve visual function as well as cosmetic appearance.  Children with ptosis should have ophthalmic examinations early in life to protect them from the serious consequences of untreated amblyopia.