Ptosis or Blepharoptosis is a medical term which is used for drooping of upper eyelids. Lowering of the upper eyelid margin can cause a reduction in field of vision when eyelids may either partially or completely obstruct pupils. Patients with ptosis therefore often have difficulty in keeping the eyelids open. As a result, they will often arch their eyebrows in an effort to raise drooping eyelids. In severe cases of ptosis, people may even need to lift their eyelids with fingers in order to see. Children suffering from ptosis may develop ‘lazy eye’ which is medically termed as amblyopia or developmental delay due to the limitation of vision.
Ptosis may be present in children or in adults as well & may be effectively treated with surgery. Following factors are associated with ptosis.
When children are born with ptosis, it is called Congenital Ptosis. Congenital ptosis is quite often caused by poor development of muscles which lift eyelids. These muscles are known as levator muscles. Moreover, congenital ptosis usually does not improve on its own over time. Children with moderate to severe congenital ptosis may need treatment in order to have their vision develop normally.
Children who are born with moderate or severe ptosis symptoms require surgical treatment in order to develop their vision properly. Failure to provide effective treatment will most often result in diminished vision in one eye (amblyopia) & a lifetime marred with poor vision. All children suffering from ptosis, including even the mild cases, should invariably get their sight checked with the eye-care practitioner every year. This is also because human eyes change shape as we grow & sometimes vision problems develop in case condition of ptosis worsens.
In case amblyopia is not treated early in childhood there are chances it may lead to permanent loss of vision sometime later in life. A most serious problem associated with ptosis in childhood is amblyopia which is a poor vision in the eye which did not develop normal sight during early days of childhood. This usually occurs when the eyelid is severely drooping & enough to block the vision of the child. Amblyopia, more frequently can develop as ptosis generally, tends to lead to the constant blurriness of visual imagery eventually causing astigmatism. Moreover, ptosis can also hide crossed or misaligned eyes & which can also cause amblyopia.
Ptosis has many causes including age-related weakening of muscle, trauma, congenital weakness & sometimes neurologic disease. Tendons which attach the levator muscle, which is the major muscle lifting the eyelid can stretch & cause eyelids to fall as we age. This, in fact, represents one of the most common causes of droopy eyelids. Ptosis is also found to occur following routine cataract or Lasik surgery due to stretching of the tendons or muscles. Some children are also found to be born with ptosis or may in some cases acquire this condition due to neurologic reasons or trauma. Sometimes, even the facial anatomy of people causes some type of a difficulty with the levator muscles. Eye tumors, neurological disorders or systemic diseases like diabetes are other causes triggering drooping of eyelids.
Most obvious sign & symptom of ptosis is the drooping of eyelids. People with ptosis often have difficulty in seeing depending upon how severely eyelids droop. Quite often, persons suffering from ptosis are found to tilt their heads backward so as to try & see under the eyelid or repeatedly raise eyebrows in order to try & lift eyelids. The degree of droopiness among ptosis patients, however, varies from one person to another. It would be sensible for people suspecting they have ptosis to compare a recent photo of their face with another one taken at least 10 – 20 years ago so as to likely see the difference in eyelid skin. Quite often ptosis can look similar to dermatochalasis. Dermatochalasis is a group of connective tissue disease which usually causes the skin to hang in folds. This disease is usually associated with the less-than-normal formation of elastic tissue.
Surgery usually is the best form of treatment for drooping of eyelids. Ptosis can be effectively corrected through surgery which usually involves tightening of the levator muscle in order to elevate the eyelid. In severe cases of ptosis, where the levator muscle is extremely weak, a ‘sling’ operation is performed which enables the forehead muscles to elevate the eyelids. This procedure, in fact, is designed to substitute levator muscles with forehead muscles in lifting eyelids. Other types of repairs include surgery on the muscle located on the inside of the eyelid in smaller cases of ptosis. Surgeons generally perform tests in order to determine the best form of ptosis correction for each patient. Nevertheless, the goal of correction surgery is to elevate the eyelid so as to permit a fuller field of vision & to achieve symmetry when compared with the opposite upper eyelid. Apart from this, ptosis surgery is also able to give patients improved vision & appearance as well.
Eyelids may not appear symmetrical following ptosis surgery, even though they are now higher placed than they were before surgery. Eyelid movement may also be lost in very rare cases. Nevertheless, it is extremely important that patients choose their surgeons very carefully as poorly performed surgery can result in undesirable appearance or in dry eyes caused from lifted eyelids that do not close completely. Patients must, therefore, ask their surgeons as to how many such procedures they have performed in the past before agreeing to their own ptosis surgery. It would also be sensible for patients to see before & after photographs of previous patients & ask if they can talk to any one of them about the kind of experience these patients have had in the past.
People must look for a cosmetic & reconstructive facial surgeon specializing in eyelids, orbits & tear drain system while choosing a surgeon to perform ptosis surgery. He should be a board certified Ophthalmic Plastic & Reconstructive surgeon who knows the structure & anatomy of eyelids & the orbit alongside having undergone extensive training in ophthalmic plastic reconstructive & cosmetic surgery.
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