Eyelid ptosis: types, symptoms, causes and treatment

Eyelid ptosis is a disorder that affects the eye, Causing fall of the upper eyelid, which generates a series of visual and aesthetic problems in the sufferer.

In this article, we explain what eyelid ptosis is, how the different types are classified, what are the symptoms associated with this condition and the treatment indicated.

    What is eyelid ptosis?

    Eyelid ptosis, blepharoptosis, or droopy eyelids, is a condition that causes the upper eyelid to droop. This situation prevents the person from opening the affected eye properly, which causes fatigue and makes it difficult to see.

    This pathology affects all ages, although it has a higher incidence in adults. When it occurs in children, called infantile eyelid ptosis, can cause amblyopia (Also known as lazy eye) and, as a result, loss of visual acuity because the eye does not receive the visual stimulation necessary to develop normal vision.

    Under normal conditions and with the gaze in front, the upper eyelid covering the cornea measures approximately 2 mm. Eyelid ptosis can cause partial or complete occlusion of the pupillary area, With the visual deficit that this causes.

    Classification and types of ptosis

    Eyelid ptosis has been classified indiscriminately by different authors, Depending on factors such as the time of its onset, the cause, the function of the lifting muscle of the upper eyelid or the degree of eyelid droop, among others.

    The most common classification groups them into: myogenic, aponeurotic, neurogenic, mechanical and traumatic.

    1. Myogenic ptosis

    Congenital myogenic ptosis usually appears at birth with a clear hereditary component, specifically of the autosomal dominant type (The disorder can appear if the abnormal gene is inherited from only one parent) and is sometimes linked to gender.

    It can be congenital or acquired. Congenital can, in turn, be simple myogenic, and is the most common type in childhood, being home to elevating muscular dysgenesis. It manifests from birth and remains stable. Three out of four are unilateral (in one eye), and those that are bilateral are usually asymmetric.

    2. Aponeurotic ptosis

    Aponeurotic ptosis they are caused by an alteration of the fascia (The connective membrane that covers the muscles), either congenital or acquired, by disinsertion, stretching or dehiscence (spontaneous opening) of the lifting muscle of the eyelid.

    This type of ptosis is the most common and is usually caused by the aging of eyelid tissue, which is why it is also called senile ptosis.

    3. Neurogenic ptosis

    Neurogenic ptosis occurs rarely. They can be caused by aplasia (lack of development) of the nucleus of the skull pair III, Due to peripheral, nuclear or supranuclear injuries.

    Although this type of ptosis is usually administered in isolation, cases have been reported associated with other neurological manifestations, such as: ophthalmoplegic migraine, which causes headaches on one side of the head or around the eye; Horner’s syndrome, which causes neurosympathetic paralysis and pupillary disorders; or Marcus-Gunn’s ptosis, in which ptosis occurs in the face of certain movements of the mouth or jaw.

      4. Mechanical ptosis

      Mechanical ptosis occurs when the weight or volume of the eyelids increases. This type of paints they get complicated in the long run with lifting eyelid disinsertions, causing aponeurotic ptosis.

      This group of ptosis includes: edema of the eyelids from various causes; eyelid tumors; orbital tumors; dermatocalasia or excess skin on the upper eyelid; and cases of conjunctival scarring, in which there is a shortening of the funds of the conjunctival sac that pulls the eyelid.

      5. Traumatic ptosis

      Traumatic ptosis arises from trauma that affects the fascia, the levator muscle of the upper eyelid, or the nerve itself. This type of ptosis usually occurs more frequently in people over the age of 18.

      Traumatic impacts can be of various types, although in most cases they occur due to a penetrating injury to the lifting muscle or through laceration or disinsertion of the fascia.

      symptoms

      The most obvious clinical sign of eyelid ptosis is drooping eyelid. Depending on the severity of eyelid droop, people suffering from this condition they may have difficulty seeing. Sometimes patients have to tilt their head back to be able to see under the eyelid, or they even have to raise their eyebrows several times to try to lift the eyelids.

      The degree of eyelid sagging is different in each person. To really know if someone has this disorder, it is suggested to compare a recent photo of the face with a photo from 10 or 20 years old. If noticeable differences are observed in the skin of the eyelid, it is advisable to consult a specialist.

      Ptosis of the eyelids may have similarities to dermatocalasia, a group of connective tissue disorders which causes excess skin on the upper eyelid. It is often caused by the passage of time, as the skin loses elasticity and builds up, causing the eyelid to appear tired and aged.

      In short, we can say that the most common symptoms associated with eyelid ptosis are the following:

      • Descent of the upper eyelid which partially or completely covers the eye.
      • Reduction of the visual field according to the closed pupillary zone.
      • Need to tilt your head back.
      • In some cases, the person has to lift the eyelid with their own finger.

      treatment

      Treatment of ptosis he usually needs surgical procedures. The aim of the surgery is to repair the muscle that lifts the eyelid or, in the event that it is not functioning and is completely immobile, to use the forehead as an accessory mechanism, so that an anchor point can be found. in muscle. Located on the eyebrows to take advantage of their mobility.

      This type of treatment, called blepharoplasty, is a non-invasive cosmetic procedure which is performed on the upper eyelids. During the procedure, the excess skin and fat found on the eyelids is removed, so that the patient can return to a normal appearance.

      These are relatively quick interventions (between 45 minutes and 1 hour) that are performed under local anesthesia, have a short recovery period and do not require hospitalization.

      this procedure it is not without contraindications, Not recommended for people with health problems that may increase the risk of the procedure. It is also not recommended for pregnant women or patients with dry eye, hypertension, diabetes, healing problems, active infections or retinal detachment.

      Bibliographical references:

      • Clauser, L., Tieghi, R. and Galie, M. (2006). Ptosis of the eyelids: clinical classification, differential diagnosis and surgical guidelines: an overview. Journal of Craniofacial Surgery, 17 (2), 246-254.
      • Junceda J., Hernández L. (1996) Ptosis of the eyelids: basic principles and surgical technique. Allergan Editorial
      • Ortiz, S., Sánchez, BF (2009) Ptosis of the eyelids. Annals of ophthalmology 17 (4) 203-213
      • Manual of diagnosis and treatment in ophthalmology. Editorial Medical Sciences. Havana, 2009.

      Leave a Comment