Key Takeaway
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Ptosis is a condition characterized by the drooping or sagging of the upper eyelid, which can obstruct vision and lead to additional issues. In this article, let’s explore what ptosis is, the symptoms of ptosis, and the various types of ptosis, each of which has its own treatment guidelines.
What is Ptosis
Ptosis, or drooping eyelid, is the condition that occurs when the upper eyelid hangs lower than normal, typically resting at the edge of the pupil. This condition can create an uneven appearance if it affects one eye or a tired look if both eyelids droop.
People with ptosis eyes may also have trouble seeing in the upper part of their vision, which can cause them to raise their eyebrows or tilt their heads back to see better, affecting their overall look. Furthermore, drooping eyelids can put pressure on the cornea, which might lead to astigmatism and decrease the amount of light entering the eye. This can result in blurry vision, especially in dim lighting.
Symptoms of Ptosis
The symptoms of ptosis (drooping eyelids) include:
One or both upper eyelids sag, potentially covering the pupil.
Reduced ability to see in the upper field of vision.
Seeing two images instead of one.
A constant feeling of tiredness in the eyes.
Increased tear production.
Discomfort when trying to blink or close the eye.
Vision may become unclear, especially if the eyelid droops significantly.
Frequent headaches or feelings of dizziness can occur.
In children, ptosis can lead to lazy eyes if not addressed early.

Types of Ptosis
Ptosis can be classified into several types based on its onset and underlying causes. Understanding these types is crucial for determining appropriate treatment options. Types of ptosis include:
Congenital Ptosis
Congenital ptosis is a condition that is either present at birth or develops within the first year of life. It arises when the levator muscle, which is responsible for raising the upper eyelid, fails to develop correctly during fetal growth.
Untreated congenital ptosis can lead to improper vision development and amblyopia (lazy eye). Children may also experience neck pain from tilting their heads back to see better. Surgical intervention is typically recommended early in life to address cosmetic concerns and prevent vision issues.
Aponeurotic Ptosis
Aponeurotic ptosis, or involutional ptosis is the most common form of acquired ptosis, primarily affecting ptosis in the elderly. It results from the stretching of the levator muscle due to aging or prolonged eye rubbing caused by allergies or discomfort. This type can significantly impact vision and appearance. Aponeurotic ptosis can cause by several factors include:
Traumatic Ptosis: Caused by injuries to the eyelid muscles.
Mechanical Ptosis: Occurs when a growth or mass on the eyelid adds weight, stretching the levator muscle.
Myogenic Ptosis: This form is associated with muscle disorders, such as muscular dystrophy.
Neurogenic Ptosis: This results from nerve damage that affects eyelid movement and is often linked to neurological disorders like Horner syndrome or myasthenia gravis.

Treatment Guidelines for Congenital Ptosis
Congenital ptosis can be treated using both surgical and non-surgical approaches, depending on the severity of the condition and how it affects vision and appearance.
H3: Non-Surgical Treatment for Congenital Ptosis
In mild cases of congenital ptosis where vision is not notably impacted, non-surgical congenital ptosis options may be considered. These include:
Observation: Regularly monitoring the condition to assess any changes or progression without immediate intervention.
Regular Monitoring: Referring to the method of using external photographs to track changes. Patients should be checked every 3-12 months for signs of amblyopia or worsening ptosis.
Vision Therapy: This involves exercises designed to improve visual function and may be recommended if there are concerns about amblyopia.
Use of Eye Patches: Patching the stronger eye can help strengthen the weaker eye in cases of amblyopia, promoting better visual development.
Surgical Treatment for Congenital Ptosis
Surgery treatment for congenital ptosis is typically recommended when ptosis affects vision or causes significant cosmetic concerns. Surgical options include:
Levator Muscle Resection: Shortening the levator muscle to raise the eyelid, suitable for patients with moderate levator function (4-8 mm).
Frontalis Sling Procedure: Allowing the eyebrow's movement to lift the eyelid by attracting the eyelid to the muscle of the forehead for patients with poor levator function (less than 4 mm).
Conjunctival Approach: A technique involving access through the conjunctiva to adjust eyelid position, often used in specific cases.
Combination Procedures: Utilizing multiple techniques may be necessary for optimal results, especially in complex cases with varying degrees of ptosis.
Treatment Guidelines for Aponeurotic Ptosis
Aponeurotic ptosis treatment options vary as congenital ptosis treatments. Treatment options for aponeurotic ptosis can be broadly categorized into surgical and non-surgical approaches.
Non-Surgical Treatment for Aponeurotic Ptosis
Non-surgical treatments for aponeurotic ptosis are generally considered for patients with mild ptosis or those who prefer to avoid surgery. These methods are often used in cases where the levator muscle function is adequate but the eyelid position is not optimal. Non-surgical treatments include:
Observation: This involves monitoring the condition without immediate intervention. It is considered when ptosis does not affect vision.
Vision Therapy: This may include exercises designed to strengthen the eye muscles and improve coordination. It can be beneficial in cases where ptosis is associated with muscle fatigue or weakness.
Eyelid Taping or Patching: This method involves using tape or patches to hold the eyelid in a higher position temporarily. It is a simple, non-invasive technique that can improve vision and cosmetic appearance, especially during specific activities.
Pharmacologic Testing: Topical medications like phenylephrine can be used to assess levator muscle function. A positive response (temporary elevation of the eyelid) may indicate that surgical intervention could be beneficial.
Regular Follow-ups: Continuous monitoring allows for timely intervention if the condition worsens. Regular check-ups can help assess changes in eyelid position and function over time.
Surgical Treatment for Aponeurotic Ptosis
Surgical treatments for aponeurotic ptosis are recommended for patients with significant eyelid drooping affecting vision or quality of life. Surgical options depend on the degree of ptosis and levator muscle function. Surgical treatments include:
Levator Aponeurosis Resection: This procedure involves resection and advancement of the levator aponeurosis. It is indicated when there is fair to good levator function (typically less than 5 mm).
Frontalis Sling Procedure: Used primarily in cases with poor levator function (less than 4 mm). This technique allows brow elevation to assist in lifting the eyelid by suspending the eyelid from the frontalis muscle using a sling material.
Anterior Approach Repair: Involves making an incision along the upper eyelid crease to access and correct the levator aponeurosis directly. This method provides good cosmetic results and allows precise adjustments during surgery.
Posterior Approach Repair: This technique accesses the levator muscle through a conjunctival incision, minimizing visible scarring. It is particularly useful for patients with minimal ptosis and good levator function.

Surgery for Ptosis at Saonanon Clinic: Techniques and Benefits
Saonanon Clinic is a specialized clinic in Bangkok focusing on plastic surgery and ophthalmology, with particular expertise in surgery for ptosis. Here, We prioritize the results and satisfaction of every client above all else. Choosing to have surgery for ptosis at Saonanon Clinic is better than elsewhere for the following reasons:
Specialized doctors experienced in surgery for ptosis. Every case is handled by Associate Professor Preamjit Saonanon, MD, an expert in oculoplastic surgery.
The clinic is clean and meets high standards.
Provide surgical reviews that allow you to compare the before and after results.
Summary
Ptosis eyes is the condition that occurs when the upper eyelid hangs lower than normal, typically resting at the edge of the pupil. Ptosis can be divided into two main types based on the cause and timing of onset: congenital ptosis and aponeurotic ptosis. Each type has different treatment approaches to ensure appropriate and effective care. It is advisable to consult an ophthalmologist for the best outcomes.
Frequently Asked Questions About Ptosis (FAQs)
Can ptosis occur due to other diseases and conditions?
Yes, ptosis can arise as a result of various diseases and conditions. Some of the notable causes include: Myasthenia Gravis, Oculomotor Nerve Palsy, Horner’s Syndrome, Neuromuscular Disorders etc. Each of these conditions requires specific diagnostic approaches and treatment strategies tailored to the underlying cause.
Can ptosis occur in one eye?
Yes, ptosis can occur in one eye, a condition known as unilateral ptosis.
Can Ptosis go away on their own?
In some cases ptosis can go away on their own. However some types of ptosis need medical treatment.
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