Ptosis
(Drooping Upper Eyelids)
The most common type of eyelid malposition is ptosis, which contributes to visual problems in many people. In adults, there are two main varieties that cause visual obstruction and other symptoms.
Some people have excess skin which falls over the eyelashes. The skin rests on the upper eyelids and contributes to a sensation of “heavy” or “tired” eyes. There are commonly prolapsed fat pads which increase the swelling or “puffy” appearance. The excess tissue causes visual field obstruction, particularly to the sides.
Other people have minimal skin excess, but instead have eyelids that actually rest several millimeters lower than the natural position and block the pupil. This situation occurs when the muscle that lifts the eyelid (levator muscle) becomes disinserted, often from trauma or advanced age. The only treatment for this condition involves repair of the muscle.
There are other, less common causes of ptosis in adults. Neurological and muscular impairments may lead to abnormal eyelid position. In these cases, the extent of ptosis may be severe. CVAs may cause ptosis, but are usually associated with cranial nerve palsy. Myasthenia gravis can cause one or both upper lids to droop. The ptosis usually improves immediately after sleep, and worsens as the day progresses. Muscular abnormalities, such as myotonic dystrophy and chronic progressive ophthalmoplegia, are often associated with systemic problems.
Patients with Bell’s palsy often develop eyelid abnormalities. The condition usually presents with poor eyelid closure and upper lid retraction (higher position than normal). The opposite (non-involved) eyelid may appear to be drooping when compared to the elevated lid. Also, aberrant regeneration commonly occurs months or years after onset of Bells’ palsy. An eyelid that initially demonstrated retraction may develop ptosis.
Thyroid eye disease frequently affects the eyelids. Often, one or both upper lids develop retraction, giving the appearance of “bulging” eyes. If only one lid becomes retracted, the other lid may appear to have ptosis, even though it is not involved in the process.
When the upper eyelids appear asymmetric, other causes of ptosis should be considered. Eyelid cellulitis or chalazions may give the appearance of ptosis. Orbital tumors may also cause eyelid malposition.
Regardless of the etiology, ptosis causes visual impairment. Patients often are bothered by decreased peripheral vision, particularly when looking up or to the side while driving. Other people notice a heaviness or tiredness through the day, particularly when reading.
While some people request correction of ptosis to improve their appearance, it is considered a reconstructive procedure that restores the eyelid to its natural position. Most insurance plans provide coverage for repair if the vision is blocked. Photographs and automated visual field testing in the office will substantiate the claim.
Repair of the condition involves a minor procedure, usually performed in the office under local anesthesia. A small incision is place in the eyelid crease. Any excess skin can be removed. The muscle that lifts the eyelid is identified and reattached to its normal position. Several dissolving sutures are placed, and the incision heals within a few days, leaving no visible scar.
|
