The Five Senses and Beyond: The Encyclopedia of Perception - Jennifer L. Hellier 2017

Ptosis

When the upper or lower eyelid is drooping, the medical term used to describe this condition is ptosis. It is derived from a Greek word meaning “to fall” and the “p” in “ptosis” is silent. Thus, the word is pronounced / ’tōsəs/. Ptosis occurs when the muscles of the eyelid (the levator palpebrae superioris and the superior tarsal) are weakened or paralyzed and are unable to raise the eyelid. Over the course of the day, the weakened muscles can become tired and the drooping is usually worse in the evening compared to the morning.

Signs and Symptoms

Ptosis can affect one or both eyes. With ptosis, the drooping upper eyelid reduces a person’s field of vision. Depending on how much the eyelid droops will determine how much of the visual field is affected. Thus, individuals with ptosis will compensate for their reduced vision by arching their eyebrow to raise the affected eyelid. If the ptosis is severe, a person may have to physically lift the eyelid with the fingers to be able to see. Additionally, if severe ptosis is left untreated, it can produce other eye conditions such as amblyopia (“lazy eye”) or astigmatism (blurry vision from a misshapen cornea).

Causes

Ptosis may occur at any age but it is predominantly seen in the elderly as the eye muscles weaken with age, as does the skin of the upper eyelid. Specifically, the tendon that supports the levator palpebrae superioris muscle becomes stretched over time. Thus, the tendon cannot hold the eyelid open as well, making it the most common cause of ptosis. The tendon and/or muscle can also be stretched during eye surgery, such as cataract removal or LASIK (laser-assisted in-situ keratomileusis). Excess baggy skin of the upper eyelid can add to the severity of the ptosis.

If an infant is born with ptosis, it is an inherited condition called congenital ptosis and its cause is currently unknown. If ptosis is diagnosed in a young child, it must be corrected quickly to avoid permanent damage to the child’s eyesight. Ptosis can also be caused by damage to the superior cervical sympathetic ganglion (part of the autonomic nervous system) or to the cranial nerve supplying the eyelid muscles, which is the oculomotor nerve (cranial nerve III). Damage to this nerve is usually a sign of an underlying disease or disorder such as a brain tumor, diabetes, drug abuse, myasthenia gravis, or stroke, to name a few. Persons who abuse (take multiple and/or high doses) opioid drugs (either illegal or prescription) may have a side effect of ptosis. The most common opioid drugs that can produce ptosis are heroin, hydrocodone (Vicodin), morphine, oxycodone (Oxycotin), or pregabalin (Lyrica).

Treatment

To date, the best way to treat ptosis is by surgery. An ophthalmologist who has experience in cosmetic and reconstructive facial surgery and who specializes in the eyelids will need to tighten the tendon of the levator palpebrae superioris muscle or may have to tighten the muscle itself. In some cases, if the muscle is too stretched or weakened, then a “sling” may need to be made. In this operation the forehead muscle will be used to hold the eyelid up. The main goal for a successful surgery is providing a complete field of vision for the eye as well as symmetry with the unaffected eye’s upper lid.

Jennifer L. Hellier

See also: Amblyopia; Astigmatism; Cranial Nerves; Diplopia; Hyperopia; Myopia; Visual Fields; Visual System

Further Reading

American Society of Ophthalmic Plastic & Reconstructive Surgery. (2015). Ptosis (droopy upper eyelid). Retrieved from https://www.asoprs.org/i4a/pages/index.cfm?pageid=3669

Bagheri, Abbas, Mehdi Tavakoli, Hadi Najmi, Reza Erfanian Salim, & Shahin Yazdani. (2016). Comparison between eyelid indices of ptotic eye and normal fellow eye in patients with unilateral congenital ptosis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 69(1), e5—e9. http://dx.doi.org/10.1016/j.bjps.2015.10.004

Finsterer, Josef. (2003). Ptosis: Causes, presentation, and management. Aesthetic Plastic Surgery, 27(3), 193—204.