PTOSIS
What is ptosis?
Ptosis is drooping of the eyelid. The eye appears smaller, there is difficulty opening th e eye. Ptosis may occur in one eye or both eye. There is obstruction of vision and a sleepy and tired appearance.

Why does ptosis occur?
There is a muscle in the upper lid, called the levator- the function the levator is the lift the eyelid open. If the levator is not working well, the eyelid droops.
In many patients who have ptosis since birth, the levator muscle is weak since birth.
In patients where ptosis starts later in life, there may be multiple causes : injury, age, use of contact lens for many years, some neurological diseases.

Do we need to consult a neurologist?
A small proportion of ptosis stems from neurologic diseases. Usually the oculoplasty surgeon is able to differentiate these on examination. They will then refer you to a neurologist.

How important is it to correct ptosis?
For an adult, a ptosis can block part of the visual field, obstructing the vision. There can be strain by lifting the brow muscles to compensate. More and more people opt for ptosis correction to avoid looking tired, sleepy and unhappy.

In a child, the ptosis may cause delay in the development of vision, and a lazy eye (amblyopia). This has to be corrected at a young age, and appropriate glasses and exercise started. Once the patient is older, vision correction cannot be achieved. It is extremely important to have an accurate assessment of vision in a child with ptosis.

What are the methods of correction of ptosis?
The oculoplasty surgeon assesses the measurements of the eye. If the natural muscle can be strengthened with stitches, that is the method of choice. If the natural muscle levator is too weak for correction, an implant (most commonly silicone) is places to connect the forehead muscles and the eyelids. The patient can then effectively use the forehead muscle to lift the eyelid.
Some neurologic diseases such as myasthenia can be treated by oral medicines.
Rarely, there are some ptosis patients where it is not safe to do surgery. These patients are recommended crutch glasses, spectacles which prop the eye open.

What are the outcomes with ptosis surgery?
After ptosis surgery, the final outcome is known at 6 weeks .This is because each person’s body heals in a slightly different way, and a small percentage of uncertainty remains. Eight of ten patients have the eyelid set exactly at the correct height, two may be little higher or lower.

Usually the eyelid height is equal when the patient looks forward, but some difference is seen when the patient looks upward or downward. In a few patients, when the patient sleeps after surgery, a small gap may remain open in the eyelids. A silicone sling when used, has greater flexibility, allows natural blinking, and can be re-adjusted if required.

Article by
Narayana nethralaya