Ptosis/droopy eyelid


Ptosis or droopy eyelid occurs due to dysfunction of muscle which lift the eyelid (levator).


Symptoms and causes
When one gets older, s/he noticed the eyelid has dropped.  Sometimes it associated with excess skin on upper eyelid (dermatochalasis) and droopy brow.  S/he will note reading/ watching TV/ driving is getting difficult towards the end of the day.  Some will note upper corner of the visual field no longer visible.  This may become even more obvious after eye surgeries eg cataract surgery.  Other cause of ptosis include contact lens wear, trauma, mechanical (lump in upper eyelid causing eyelid to drop), neurological such as third nerve palsy, Horner syndrome) and Myasthenia Gravis.


Ptosis may happen to a child since birth.  Child ptosis pose a more dangerous condition as it may disturb the child’s visual development and subsequent develop lazy eye (amblyopia— normal looking eye but not able to see well). In addition, the ptosis appearance especially if it is one – sided may lead to asymmetry appearance and may affect adversely the social integration of the affected individual.

Important cause of ptosis
While most ptosis are benign, its development may associated with some serious medical conditions that require urgent medical attention

  • Develop suddenly over a short period of time
  • Droopy eyelid together with double vision
  • associated with pain, redness, bulging eyes or eye movements difficulty

Ptosis in a child

Ptosis can happen in a child.  If it occlude the visual axis, it can cause irreversible reduced vision (ambloypia).  This is actually more common if there is only one eye develop ptosis.

Bilateral droopy eyelid.  When a child is not able to see , he/she may develop behavioural issues.

Treatment

As long as it is ruled out to be neurological (myasthenia of other progressive neurological disease), the intervention is invariably surgical. The ptosis surgery which lift the eyelid  usually in the form of reattach or shortening the muscle  (levator advancement or levator resection).  However, for those with very weak levator muscle, eyelid can be lifted by using synthetic material (such as silicon rod) or fascia lata, a tough tissue from the side of the thigh.


In adult, it is usually performed under local anesthesia and the patient can go home the same day. Swelling is expected, and patient is also expected to perform ice pack and put in cream. Patient is advised to be reviewed by oculoplasitc surgeon after one week and have sutures removed.   In general, the down time is about 1- 2 weeks, but it may last longer depending on individuals.


For children and those adult which require tissue (fascia lata) harvested from the thigh, the ptosis surgery is performed under general anesthesia.   The person may find their thigh a bit sore and slightly difficult to walk for two to three weeks but usually can resume normal walking after one month.

Provided Physiotherapies

Treatment

While many medical professionals claim able to remove lesion, reconstruction of defect post excision require special trained doctors. Oculoolastic surgeons are eye plastic surgeons who are special trained to reconstruct eyelid to retain its function and make it look aesthetically acceptable.

Pre op:  Severe ptosis (Droopy eyelid), right more than left.

Post op: He looked more refreshed, energised and can see much better.

Pre op:  Severe pre op ptosis with frontalis overaction

 

Post op:  She is able to see clearly now and both eyes look symmetrical

 

Pre op:  Droopy eyelid, left > Right leading to sad look

Both eyelid looks symmetrical and better

 

Pre op:  Left ptosis in a young lady who wear contact lenses

 

Post op:  Symmetrical and natural appearance

 

Pre op:  A child with a congenital left upper eyelid ptosis.  This can affect the normal development of vision

 

Post op:  symmetrical looking eyes.  It is very difficult to take photos of a child

 

Pre op:  Age is never a hindrance.  This 85 years old lady present with droopy eyelid especially in the evening stopping her from reading.

Post op:  This 85 years old lady recovered well after surgery.  Looking more alert and can enjoy reading now.

pre op:  sometimes, ptosis can develop after cataract surgery  as speculum can easily damage the levator muscle

 

post op:  A symmetrical and natural look.

 

Pre op:  Is eyelid surgery only for woman?  No, this man feels that the droopy eyelid has hampered his vision and make people false perceive him as uninterested and tired.

Post op:  A  pair of natural well elevated eyelid gives patient a sophisticated and interested look.

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