Indication of ptosis

Ptosis, or blepharoplasty, is the drooping of the upper eyelid brought on by a congenital or acquired abnormality of the muscles that lift the eyelid (Lee, 2021). Ptosis can affect normal vision, but more importantly, it could be an indication of a serious neurological condition.

Patient Story (Lee, 2021)

After the initial evaluation of ptosis, a history and physical examination will often discover the cause. Important inquiries to ask the patient include:

• Is ptosis present from birth (congenital)?
• Did the ptosis appear suddenly or did it progress slowly over time?
• Does the degree of ptosis change throughout the day or as a consequence of fatigue?
• Do you might have other symptoms of ptosis, akin to headache or double vision?
• Have you had eye surgery or trauma (including birth trauma) previously?
• Do you wear contact lenses?
• Is there a family history of ptosis?

Eyelid ptosis classifications (Lee, 2021; Shahzad and Siccardi, 2022)

Optosis is split into congenital and bought, which is split into the next subcategories:

• : results from defective innervation of the oculomotor nerve (III) by the levator muscle, which lifts the upper eyelid. Associated with conditions akin to third nerve palsy, Horner’s syndrome, Marcs Gunn’s jaw-blinking syndrome, and multiple sclerosis.
  • Unilateral ptosis with abnormal eye movements and/or dilated pupil suggests third cranial nerve compression palsy. The causes can range in severity from mild to instantly life-threatening. Therefore, urgent neuroimaging is vital to exclude an aneurysm.
• : related to mitochondrial diseases, oculopharyngeal dystrophy and myotonic dystrophy.
• : brought on by myasthenia gravis (MG), botulinum toxin and infectious botulism.
  • Myasthenia gravis is an autoimmune disease that always presents initially with unilateral or bilateral ptosis with or without double vision and eye motility disorders. Patients with this disorder ought to be closely monitored because rapid clinical deterioration of MG may lead to respiratory failure requiring intubation.
• : a disorder of the skinny connective tissue (tendon) brought on by aging, trauma or post-operative complications.
• : levator muscle function is impaired as a consequence of an abnormal external structure akin to a tumor, a chalazion (an eyelid cyst resulting from a blockage of the sebaceous gland), an upper fornix contact lens, or a scar.
• : direct or indirect eyelid trauma.

Treatment (Shahzad and Siccardi, 2022)

The selection of treatment will rely on the cause, the severity of the ptosis, and the function of the levator muscle. For myogenic and neurogenic ptosis, non-surgical methods are used, which include eye drops, taping the upper eyelid and attaching eyelid balls to glasses. Surgery is required for congenital ptosis, when ptosis causes vision problems, and when non-surgical treatments are ineffective. If ptosis is diagnosed in a primary care clinic, the patient ought to be referred to a neurologist and/or ophthalmologist for further treatment.

Lee, M. S. (2021, March 17). Overview of ptosis. . https://www.uptodate.com/contents/overview-of-ptosis

Shahzad, B., & Siccardi, M. A. (2022, August 8). Prolapse. https://www.ncbi.nlm.nih.gov/books/NBK546705/