What is a drooping eyelid (blepharoptosis)?
Ptosis is falling of the upper eyelid, partially or completely, causing a reduction of the palpebral fissure, which interferes with normal vision. In practice, we speak of ptosis when the eyelid obscures at least 2 mm of the iris. Ptosis may be observed on one or both sides. This condition may occur in both adults and children in whom it may be present since birth, but may be manifested only in older age. In most cases, ptosis is considered an aesthetic defect. However, if the eyelid obscures the pupil, meaning that the ptosis is more advanced, this may lead to amblyopia. This in turn, may have a negative impact on everyday functioning, interfering e.g. with walking or reading. In order to reduce problems with functioning, some patients position their head at a different angle, which may cause headaches or permanent changes in the musculoskeletal system. Ptosis may also have psychological consequences, especially in children and teenagers, since it may translate into problems with acceptance in the peer environment, or cause problems at school.
Causes of ptosis
Ptosis may have the following types of causes:
Ptosis may also be a sign of other diseases, e.g. congenital or acquired oculomotor nerve palsy (failure to raise, lower or abduct the eyeball), congenital or acquired Horner’s syndrome (ptosis, miosis, much reduced sweating (anhidrosis) and reduced iris pigmentation on the affected side). It may also be a quite common, non-specific, often the first and only sign of local or generalised muscle disease, e.g. muscular dystrophy, oculopharyngeal muscular dystrophy or chronic progressive ophthalmoplegia, autoimmune diseases, such as myasthenia gravis, or one of the manifestations of orbital tumour.
Ptosis in children – when to treat?
Congenital ptosis, usually unilateral, may be of various severity: from slight drooping of the eyelid up to complete eyelid closure (in extreme cases). This is a result of abnormal development of the levator palpebrae, i.e. the muscle that lifts the eyelid. In the early childhood, ptosis obstructing the pupil has a negative effect on the vision development and results in amblyopia. In order to enlarge the visual field, children tilt their head backwards or raise their eyebrows, which, in the long run, may contribute to spinal deformation, especially in the cervical segment. To avoid consolidation of amblyopia and problems with the musculoskeletal system, surgical treatment of ptosis should be implemented as early as possible.
A surgical procedure is indicated in the event of ptosis which obstructs the pupil and has a negative effect on the vision function. In milder ptosis, prompt surgical intervention is usually not necessary. However, frequent ophthalmological check-ups are indicated, every 3-12 months, depending on the child’s age and symptom severity, with special regard to the possibility of developing amblyopia.
A diagnosis of drooping eyelid starts with a clinical examination of the patient, accompanied by auxiliary examinations and specialist consultations. The physician taking medical history asks about hereditary burden and occurrence of similar cases in the family. He/she also collects information on the past surgeries of the eyeball, eyelids and orbit, past head injuries with special consideration of the orbito-palpebral region and brain, and on comorbidities. During a physical examination, the doctor assesses the function of the levator palpebrae superioris, which is very important for the selection of the planned treatment method. He/she also examines the palpebral fissure height, the contour line of the upper eyelid margin, and the location of the upper eyelid fold. The diagnostics may also include other tests, especially if ptosis is suspected to be a sign of other diseases. Patients with neurological symptoms may require magnetic resonance imaging (MRI) and computed tomography (CT) of the brain, facial skeleton and orbits with contrast. In patients with oculomotor nerve palsy, angio-CT examination is performed. If there are symptoms of acquired Horner’s syndrome, the diagnostic tests should include MRI or CT of the brain, neck, spine and chest, which may help exclude organic changes causing damage to the sympathetic nervous system.
Ptosis, i.e. the drooping of upper eyelid, is treated during a surgical procedure. The choice of the treatment method depends on the fact if the patient had been previously operated and if the function of the levator palpebrae superioris is preserved. In the event of severe ptosis, the aim of the procedure is to improve visual functions and prevent complications on the part of the musculoskeletal system. If ptosis is rather a cosmetic defect, the aim is to achieve a younger, and more aesthetic appearance. At our Centre, we perform the following procedures of ptosis correction:
- transconjuctival resection of Müller’s/tarsal muscle,
- repair procedures of the levator palpebrae superioris aponeurosis,
- suspending the eyelid on the frontalis muscle.
The surgical procedure is performed under local anaesthesia in adults, and under general anaesthesia in children. The duration of the procedure may vary, and depends on the complexity of ptosis and on the fact if it affects one or two eyelids – on average 1 to 3 hours. The incisions are made from the conjunctival side or at the site of natural palpebral fissures, so as to hide the scars. The frontalis suspension is an exception. The sutures, depending on the surgical method, are removed after about 7-14 days. Follow-up examinations, including ophthalmological check-ups, are recommended after the surgery. Subjects whose ptosis is of varied nature (myasthenia gravis, muscular dystrophy, oculopharyngeal muscular dystrophy, etc.) require constant care of many specialists, and, in certain cases, another surgical intervention.
Oculoplasty at OCHO
Oculoplastic surgeries at OCHO are performed by: Professor Guy Ben Simon at the invitation of Professor Zagórski and with consent of the Regional Medical Chamber, and our surgeons working with him, including: Dr Justyna Kłos-Rola and dr Marta Piecyk-Sidor in Nałęczów, as well as dr Agnieszka Mielnik-Mierzwińska and dr Arkadiusz Pogrzebielski in Kraków.
FAQ
During a basic ophthalmological visit, the patient’s ophthalmological history is taken, and the following examinations are conducted: autorefraction, keratometry, intraocular pressure measurement, visual acuity examination, slit lamp examination and fundoscopic examination.
In most cases, yes. If the doctor decides that some additional examinations are necessary, they may be performed during the visit, or if the doctor does not perform that kind of examinations, the patient is referred to another specialist.
An ophthalmological visit with performance of basic examinations lasts about 20 minutes. In some Centres, the examinations being part of the visit are performed by auxiliary personnel in the examination room. These activities are also included in the time of the basic visit.
Yes, it is recommended that contact lenses be removed before the visit. The patient should bring the lenses to the visit, since the doctor may ask the patient to insert them.
The cost of a visit is as per the price list on our website.
The waiting time for a private visit is up to a week. This time may be longer if the patient wants to see a particular specialist. The waiting time for a National Health Fund visit is according to the waiting list. Please call or e-mail us to appoint a specific date.
Yes, but you should inform the doctor that you would like to select glasses or lenses at the beginning of the visit.
Yes, you should normally apply your eye drops.
An ophthalmological visit does not require special preparation. If this is your first visit at the centre, you should have the identity card, which is necessary to create a patient record. Also remember that in most cases it is not allowed to drive a car after an ophthalmological visit.
During the first visit, the doctor takes the patient’s ophthalmological history. If the patient has any ophthalmological documentation from other institutions, it is worth taking it to the visit.
You can return to work/school after the ophthalmological visit, but please remember that if you received eye drops at the visit, your vision may be disturbed and blurred for about 2-3 hours.
Ophthalmological check-ups is an individual matter. The doctor usually informs the patient during the visit when he/she should return. Patients over 50 should have a check-up at least once a year.
If you received pupil-dilating drops at the visit, you must NOT drive a car directly after the visit. You should wait for about 2-3 hours.