Ptosis, Causes and Treatments

What is ptosis?

The medical term ptosis defines a situation in which there is a drooping of the upper eyelid. This drooping can cause, apart from the aesthetic problem, a decrease in visual acuity due to occlusion of the pupillary axis by the eyelid or a decrease in the upper visual field. Patients often try to open their eyes by raising their eyebrows to compensate for the loss of function of the levator muscle of the eyelid with the frontalis muscle. Because of this effort, many patients complain of fatigue in the frontal region and heaviness in the eyelids.

Occasionally, they resort to using their fingers to lift their eyelids. In children, apart from the aesthetic problem, occlusion of the visual axis by the eyelid can lead to lazy eye.

What causes it?

There are multiple causes of ptosis. The most frequent, in adults, is due to a disinsertion of the levator muscle of the eyelid, which is the main muscle responsible for the function of the eyelid lifting. Other causes of disinsertion are eye surgeries or prolonged use of contact lenses. In children, the most frequent cause is a congenital weakening of the levator muscle. However, there are other less frequent causes such as muscular diseases (dystrophies, myopathies, myasthenia gravis…), neurological diseases or trauma.

How are they treated and what are the results obtained?

Except in exceptional cases, associated with neurological diseases, most ptosis can be treated surgically. Normally, the intervention consists of shortening or reinserting the levator muscle through an incision in the palpebral sulcus, so that the scar is concealed. In cases of extreme weakness of the levator muscle, surgeries called frontalis suspension surgeries can be performed, which consist of placing bands of autologous material (the patient’s own) or inert synthetic material, through small incisions in the eyelid and forehead, which allow elevating the eyelid taking advantage of the function of the frontalis muscle. There are other less common procedures based on shortening of small muscles of the eyelid called conjunctivomüllerectomies.

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In all cases, before proceeding to the surgical correction of ptosis, a study and a correct exploration must be performed to determine the type of intervention to be performed in each specific case. The aim of the surgery is to improve the aesthetic aspect, looking for the greatest possible symmetry between the two eyes, and a correct palpebral opening and closing.

Normally, the results are satisfactory, although there is a percentage of reoperations that ranges between 5-20% of the cases, depending on the different surgical techniques and the complexity of the cases. As any other surgery, ptosis surgery is not free of risks and complications such as the impossibility of palpebral closure (lagophthalmos), hypocorrection, hematoma and palpebral edema, alterations in the shape of the palpebral margin, infections and granulomas. Oculoplastic ophthalmologists have been trained for years in the different surgical techniques for the correction of ptosis and are the best qualified to solve the potential complications that may arise in the postoperative period.