Drooping eye lid, also known as Ptosis, is the excessive sagging or drooping of the upper eyelid either in one eye or both eyes at the same time. This is a problem that occurs in older people because of ageing although sometimes it can affect children too. It is a condition that can stay constant, progressively worsen, or intermittently come and go.
In some instances, the drooping may be difficult to notice but in others, the entire pupil may be covered by the eye lid. But the drooping varies from person to person depending on the degree of severity of the drooping lid. Without keenness, ptosis can be confused with dermatochalasis, which is a disease of connective tissues that makes the skin to hang in folds. In this case, only the doctor can do an eye examination to determine whether this is the cause.
Ptosis in children
Some children may be born with this condition. Whether it is moderate or severe ptosis, the children would require quick and proper treatment during their young age for them to develop their vision properly. Otherwise, the children’s vision may diminish either in one or both eyes and may end up with poor vision all their lives. This condition is called amblyopia.
Such children affected by Ptosis should be taken to their eye doctors at least every year. This is because as children grow up, their eyes keep changing their shapes. And as the ptosis also increases or worsens, it may lead to both visual and focusing problems in children.
Signs and Symptoms
The following signs and symptoms may be put into consideration:
• Eyelids drooping down in front of the eyes.
• Difficulty to close or blink the eye
• Eye fatigue
• Poor vision, double vision or blurring.
• Crossed eyes
• Tilting the head back to try to see
• Trying to lift the eyelid by repeatedly raising the eyebrows.
Other symptoms that may also be related to this condition include:
• Eyelid swelling
• Itchy eyelid
• Eyelid lump
• Eyelid twitch
• Weak eye muscles
• Eyelid symptoms
The drooping may also become worse after being awake for a long time or after one’s muscles have become tired. This is sometimes called “lazy eye” but normally it would refer to amblyopia. If the condition is left unattended, it would develop other conditions like amblyopia or astigmatism.
Ptosis may exist at birth (congenital ptosis) or it can develop during one’s lifetime because of age, injury or even after an eye surgery, etc.
Let us have a look at some of these causes:
Drooping in both eyelids
• Migraine headaches
• Medical problem, such as myasthenia gravis
• Normal ageing process
• Normal individual variation of the eyelids
Drooping in one eyelid
• Some medical problem
• Growth in the eyelid, for instance a stye
• Some nerve injury
• Normal ageing process
• Normal individual variation of the eyelid
Other medical conditions
• Weak muscles
• Cataract surgery
• Myasthenia gravis
• Allergic reactions
• Adrenal insufficiency
• Horner’s syndrome
• Facial or eyelid paralysis
Medications causing Droopy eye lid
These are medications, drugs and substances that may have some contributing factors towards the condition:
• Ocular Eye drops
• Botulinum Toxin
• Econopred Plus
Classification depends on the cause of ptosis as follows:
1. Neurogenic ptosis: This includes oculomotor nerve palsy, Marcus Gunn jaw winking syndrome, Horners syndrome and 3rd cranial nerve misdirection.
2. Aponeurotic ptosis: Either involutional or post operative.
3. Myogenic ptosis: Includes myasthenia gravis, ocular myopathy, myotonic dystrophy, blepharophimosis syndrome and simple congenital ptosis
4. Mechanical ptosis: This occurs because of the tumors of the upper lid or edema.
5. Pseudo ptosis: This comes as a result of (a) lack of lid support, which means empty socket also called atrophic globe and (b) Higher lid position that is on the other side.
6. Neurotoxic ptosis: It is a symptom of envenomation brought about by such elapids as cobras or kraits. This also causes respiratory failure that leads to suffocation. This condition is normally caused by complete paralysis of the thoracic diaphragm.
The most important thing in diagnosis of ptosis is actually to determine its source. Diagnosis should therefore be done by an eye doctor who should conduct a thorough examination of the eyelid.
They should take into consideration the height of the eyelid and check the muscle strength of the eyelid to determine the cause of the disease.
Some of the tests that can be done include:
• Examination of the eye for any abnormalities like swelling of the conjunctiva, swelling of the eyelid, conjunctivitis, etc
• Performing a nervous system examination. This will determine if the pupil is either dilated or constricted
• Cerebral aneurism examination especially in case of unilateral ptosis
• Slit-lamp examination
• Tensilon test (edrophonium)
Some blood tests that can also be performed include:
• Full blood count and ESR
• Fasting blood sugar
• ANA autoantibodies
• Syphilis serology
• Acetylcholine receptor antibody (for myasthenia gravis)
Some urinal tests like urinalysis and other radiological investigations including x-rays can also be carried out.
For proper diagnosis, the following medical experts can be contacted for help: Neurologists, General Practitioners, Endocrinologist, Emergency physicians and Ophthalmologist.
Treatment of ptosis depends on its type. Most of the cases may be corrected by plastic surgery procedures. For example, severe aponeurotic and congenital ptosis would require surgical correction. Examples of surgical operations or procedures include:
• Muller muscle resection
• Levator resection
• Frontalis sling operation
In cases where plastic surgery may not be necessary, non-surgical methods can be employed. For example, “crutch” glasses or some special scleral contact lenses can be used to support the eyelid. This means that the eyeglass frame will have a special device attached to it that should help to hold the eyelid open.
Otherwise, any other droopy eye lid caused by a disease can be dealt with by effectively treating the disease. Temporary droops or tired eyes can easily be prevented by:
• getting enough sleep
• avoiding rubbing of the their eyes
• minimizing alcohol consumption
• Staying out of smoke-filled rooms
• Avoiding fatigue