Droopy Eyelid (Ptosis)
What is droopy eyelid (ptosis)?
Ptosis is a condition in which the eyelid level is lower than the height it should be. This condition is often unilateral but can also be bilateral. Although bilateral droopy eyelids are recognised in the late period, unilateral ones are recognised in the early period due to the asymmetry they create, even at a minimal level.
What are the types of droopy eyelids?
First of all, it is divided into congenital and acquired droopy eyelids. Acquired ptosis is subdivided into myogenic (muscle-induced), aponeurotic (caused by separation at the muscle attachment point), neurogenic (caused by the nerve innervating the muscle), mechanical (caused by a mass that causes weight on the lid, such as a tumor or excess skin) and traumatic (caused by damage to the muscle or surrounding tissues).
For the treatment of ptosis, it is necessary to first understand the cause of the disease and create a treatment plan accordingly.
What causes droopy eyelid? What are the reasons? Why is it induced?
Congenital ptosis can be seen with some genetic syndromes, but most commonly occurs idiopathically without any known cause. In babies with only droopy eyelids, not accompanied by any syndrome, there is a developmental disorder of the levator palpebra muscle.
Due to inadequate contraction of this muscle that lifts the eyelid, the eyelid cannot be lifted sufficiently and ptosis develops. At the same time, the muscle of these patients cannot relax sufficiently and the eyelid cannot be lowered when looking down.
Acquired ptosis can occur for many different reasons. In the most common aponeurotic type, the tendon called levator aponeurosis, which allows the muscle to adhere to the tissues in the lid, detaches from the place where it adheres. As a result, the muscle cannot transmit its power to the lid sufficiently and ptosis occurs. The reasons for this include old age, prolonged use of contact lenses, prolonged allergy and eye itching, and previous eye surgeries.
In the myogenic subtype, a disease develops in the muscle that lifts the lid and the muscle cannot function properly. In these patients, there are usually problems with muscles in other parts of the body or other muscles of the eye.
In another subtype, neurogenic ptosis, there is a problem with the nerve innervating the levator muscle that lifts the lid. Myasthenia gravis, 3rd nerve paralysis and Horner’s syndrome are the causes of neurogenic ptosis.
In mechanical ptosis, tissues such as excess skin on the eyelid, orbital fat tissue herniation or lid tumor prevent the lid from opening to a certain extent by weighting.
Traumatic ptosis is characterized by damage to the levator muscle or the 3rd nerve that innervates it after trauma. Trauma may also cause mechanical ptosis due to scarring of the skin or aponeurotic ptosis due to aponeurotic separation.
Can ptosis occur after eye surgery?
Eyelid ptosis can also occur after eye surgeries. Especially the aponeurosis can be damaged by the blepharostat (eye speculum), which is used to keep the eyelids open during eye surgery, and aponeurotic ptosis can occur as a result.
What are the symptoms of droopy eyelid (ptosis)?
In ptosis patients, symptoms may vary depending on the degree of droopy eyelid. In congenital ptosis, if the lid is at or below the pupil level, children may have decreased vision, i.e. lazy eye. In patients with a eyelid level higher than the pupil, lazy eye can still be seen, although less severely, due to the possibility of narrowing of the visual field and astigmatism.
In addition, although the lids of these patients are low, the lid remains higher due to the inability of the levator muscle to relax when looking down, and some patients’ eyes can not be closed during sleep at night, resulting in symptoms of dryness in the eye.
Since the lid crease line is also faint in these lids, an aesthetically asymmetry is also observed. This can cause psychological distress in children, especially at school age.
In acquired ptosis, patients mostly complain about the asymmetrical appearance created by the droopy lids. Blurred vision and headache may be observed due to the development of astigmatism. Depending on the degree of ptosis, pain may occur around the eyes and in the forehead area due to complete closure of vision or because patients try to force themselves to open the lids to see.
Does ptosis impair vision?
If the eyelid level is at or below the pupil level, vision restriction is observed. However, even if the front of the pupil is open, the astigmatism and narrowing of the visual field caused by droopy eyelids adversely affect patients’ vision.
Does droopy eyelid cause headaches?
The astigmatism caused by ptosis and the muscles in the brow area, which we use to forcefully open the lids, can cause eye pain and headaches.
Is ptosis genetic?
While it can be seen in some genetic diseases and syndromes, it mostly occurs sporadically or idiopathically.
Does droopy eyelid go away on its own? How does it resolve?
It is generally not expected to resolve spontaneously. However, in some exceptional cases, especially in neurologic or myogenic ptosis, neurologic treatments may reduce the severity of the condition.
Rarely, in patients with congenital ptosis, the level of ptosis at a very young age decreases slightly over time, but a completely normal eyelid level is never observed.
How is ptosis treated? What are the treatment methods for droopy eyelids?
As with the treatment of many other diseases, treatment should be planned for the cause. However, the main treatment method of ptosis is surgery. In congenital ptosis, different surgeries (levator procedures, frontal suspension) can be applied depending on the strength of the levator muscle.
In aponeurotic ptosis, the aponeurosis is surgically fixed to its original position. In mechanical ptosis, the mechanical cause of the ptosis is surgically removed.
In neurologic or myogenic ptosis, although neurologic correction is attempted with medication, surgical intervention may eventually be required. In traumatic ptosis, the tissues damaged by trauma are tried to be repaired surgically.
What is the healing process after eyelid surgery?
Although different techniques are applied in eyelid surgeries, postoperative care is generally similar. Preventing water from the surgical site in the first 2 days after surgery, applying eye drops and ointments at regular intervals, avoiding intense exercise especially in the first 1 week, and protecting the eye from trauma are important factors in the postoperative healing process. Generally, patients can easily return to their normal lives after the stitches are removed in the 1st week of surgery.
Laser Eyelid ptosis Surgery
Contrary to popular belief, laser is not used in the surgery. However, this surgery can be performed with the “radiofrequency” device, which is known as “laser” among the society. This device both ensures that bleeding during the case is much less and helps the postoperative recovery to be faster. Less bleeding during and after surgery means less swelling, less bruising and a faster return to normal life.
Congenital Eyelid ptosis. Treatment of Ptosis in Infants, Children
Although the treatment of congenital ptosis is mainly surgical, the issues to be considered before and after surgery are slightly different compared to ptosis in adults. In a patient with congenital ptosis, the vision of that eye should be checked first, and if necessary, glasses and closure treatment should be applied during the period until surgery.
In patients who decide to undergo surgery, the surgical technique to be used should be decided very carefully, taking into account the level of the eyelid and the strength of the levator muscle. Whether the procedure to be performed is a levator procedure or frontal suspension, the eyes may remain open in children after the surgery, and the eyes may dry out while sleeping at night. Therefore, it is very important for patients with congenital ptosis and their family to be well-informed and for the doctor to be available at all times so that they can use their medications regularly and stay under close follow-up after surgery.
Droopy Eyelid Surgery (Ptosis) Price 2023
Eyelid ptosis surgery is not uniform and the degree and causes of ptosis vary. For the price of ptosis surgery, you must first have a detailed examination. We welcome you to our clinic for this.