- Congenital Ptosis (present at birth):
- Poor development of the levator muscle: This is the most common cause, where the muscle responsible for lifting the eyelid doesn't develop properly.
- Genetic factors: Can sometimes be inherited.
- Acquired Ptosis (develops later in life):
- Aponeurotic Ptosis (Involutional Ptosis): The most common acquired type, caused by stretching, thinning, or detachment of the levator aponeurosis (the tendon that connects the levator muscle to the eyelid) due to aging.
- Neurological Conditions: Damage to the nerves controlling the eyelid muscles:
- Oculomotor nerve palsy (third nerve palsy): Damage to the nerve that controls several eye muscles, including the levator.
- Horner's Syndrome: Damage to sympathetic nerves that affect the eye and face.
- Myasthenia Gravis: An autoimmune disease that causes muscle weakness, including the eyelid muscles.
- Stroke or brain tumor: Can affect nerve pathways.
- Muscle Diseases (Myogenic Ptosis): Conditions that directly affect the eyelid muscles:
- Oculopharyngeal Muscular Dystrophy.
- Chronic Progressive External Ophthalmoplegia (CPEO).
- Trauma: Injury to the eyelid or eye muscles.
- Tumors: Tumors in or around the eyelid can cause drooping.
- Inflammation/Swelling: Swelling from infection, inflammation, or allergic reactions can temporarily cause ptosis.
- Complication of eye surgery: Rarely, ptosis can occur after cataract or other eye surgeries.
- Reduced field of vision: The drooping eyelid can block part of your vision, especially your upper field of vision.
- Eyestrain: Due to the effort of trying to lift the eyelid.
- Head tilt or eyebrow raise: Children and adults may tilt their head back or constantly raise their eyebrows to see better, which can lead to neck pain or headaches.
- Asymmetry of the eyes: One eye may appear smaller than the other.
- Fatigue of the eyelids: Eyelids may feel heavy.
- Amblyopia (lazy eye): In children, severe ptosis that obstructs vision can lead to amblyopia if not treated early.
- Detailed medical history: The doctor will ask about the onset of symptoms, any associated conditions, medications, and family history.
- Physical examination of the eyes and eyelids:
- Measurement of eyelid height (marginal reflex distance - MRD).
- Assessment of levator muscle function (how well the eyelid lifts).
- Evaluation of eye movements and pupil size.
- Slit-lamp examination: To examine the eye structures in detail.
- Visual field testing: To assess if vision is obstructed.
- Blood tests: To rule out underlying systemic conditions like Myasthenia Gravis or other muscle/nerve disorders.
- Imaging studies: MRI or CT scans may be ordered if a neurological cause, tumor, or other structural abnormality is suspected.
- Tensilon test: If Myasthenia Gravis is suspected, a medication called Tensilon (edrophonium) may be injected to see if it temporarily improves eyelid lift.
- Observation: For very mild cases that don't affect vision or are temporary, observation may be sufficient.
- Addressing the underlying cause: If ptosis is due to a treatable medical condition (e.g., Myasthenia Gravis, infection, tumor), treating that condition may resolve or improve the ptosis.
- Medications: For certain neurological causes (e.g., specific eye drops for Horner's syndrome).
- Ptosis Crutch: A non-surgical option where a small attachment is added to eyeglasses to hold the eyelid up. This is a temporary solution and not suitable for everyone.
- Surgery: This is the most common and effective treatment for persistent ptosis, especially when vision is affected or for cosmetic reasons.
- Levator Resection/Advancement: The most common surgery, where the levator muscle is tightened or reattached to lift the eyelid.
- Frontalis Sling: For severe ptosis or very poor levator function, the eyelid is connected to the eyebrow muscles, allowing the eyebrow to lift the eyelid.
- Müller's Muscle Conjunctival Resection: For mild ptosis, a small muscle inside the eyelid (Müller's muscle) is shortened.