Ptosis is a condition in which the upper eyelid droops or closes involuntarily. This problem may develop in childhood or adulthood as a result of a compromised levator muscle. One or both eyes may be affected. In some cases, eyelid droop comes and goes, posing a challenge to an accurate diagnosis.
Why does an eyelid droop?
Ptosis results from an anatomical or functional abnormality in the levator muscle. Potential causes include:
- Congenital ptosis is caused by natural levator muscle weakness.
- Levator aponeurosis is a common type of acquired ptosis caused by age-related stretching and thinning of the levator muscle in the upper eyelid.
- Nerve damage in the area of the levator muscle.
- Certain medical conditions may affect the levator muscle, including
- Horner syndrome
- Stye on the eyelid
- Tumor in the eye area
- Myasthenia gravis
- Chronic contact lens use (especially hard contact lenses)
- Ocular allergies and eye rubbing
What types of surgery can be done?
Ptosis repair is typically conducted in an outpatient setting. Findings of the diagnostic evaluation performed during the initial consultation visit dictate which surgical approach is taken. Options include:
- External ptosis repair may be suitable for people with adequate levator muscle function. In this technique, local anesthetic with sedation is administered to block pain and calm the nervous system. An incision is then made in the natural crease of the upper eyelid. The attachment of the levator muscle is repositioned to the connective tissue in the eyelid (the tarsus). Throughout the procedure, the patient may be asked to perform certain eye movements. This helps to determine the best eyelid position.
- Internal ptosis repair also focuses on the levator muscle in the upper eyelid, but it does so by turning the eyelid inside out. This technique allows the surgeon to observe both the levator muscle and Mueller’s muscle, which is also involved in lifting the eyelid. When only a mild lift is needed, the Mueller’s muscle may be tightened. The levator muscle is shortened when a more significant lift is needed. General anesthesia or sedation may be selected for internal ptosis repair.
- Frontalis sling fixation is a ptosis repair technique that may be necessary when there is poor levator muscle function. Poor muscle function is often the cause of congenital ptosis. In this procedure, a tiny silicone sling is inserted beneath the skin of the upper eyelid up to the frontalis muscle on the forehead. This allows the eyelid to be raised and lowered by elevating and lowering the eyebrows. Frontalis sling fixation is performed under general anesthesia.