Ptosis is the condition of sagging tissue. When referring to the eyes, it is a problem with drooping eyelids. It also has been used in reference to sagging breasts. The term ptosis is a Greek word that means ‘to fall’ or ‘fallen’. If ptosis of the eyelids is left untreated it may interfere with vision, so it is recommended to treat this condition in young age. Ptosis may occur in upper or lower eyelid or both.

Symptoms :

  1. Drooping of upper or lower or both eyelids
  2. Increased tear production
  3. Often interference with vision

Causes : The most common causes of ptosis are :

  1. Weakness of levator and superior tarsal muscles, that raises the eyelids, that leads to the drooping eyelids.
  2. Damage to the superior cervical sympathetic ganglion or damage to the oculomotor nerve may also leads to ptosis because these nerves control the muscles, that raise the eyelids.
  3. Looseness or sagging of the skin or muscles of the upper eyelids caused by the normal aging process.

Some diseases or illnesses may also lead to ptosis :

  1. Brain tumor or brain cancer
  2. Diabetes mellitus
  3. Horner syndrome : Horner syndrome or Bernard-Horner syndrome or Claude Bernard-Horner syndrome or oculosympathetic palsy is a disorder of having drooping of the eyelid or ptosis and constriction of the pupil or miosis
  4. Myasthenia gravis : This is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigue. This disorder often shows ptosis due to the severe weakness of eye muscle.
  5. Stroke

Drugs : Proling use of high doses of opioid drugs like morphine, oxycodone, or hydrocodone can cause ptosis.

Other : It is seen that wearing contact lenses for long periods of time may develop ptosis.

Classification : Ptosis may be classified in following types :

  1. Neurogenic ptosis : In this condition the nerve that controls the eyelid muscle are affected due to other disease or disorders like oculomotor nerve palsy (the damage to the third cranial nerve or oculomotor nerve), Horner’s syndrome (the combination of ptosis and miosis), Marcus Gunny jaw winking syndrome ( synkinesis of eye muscles ) and third cranial nerve misdirection.
  2. Myogenic ptosis : This type of ptosis occur due to the disorder or malfunction of eyelid muscles, that includes myasthenia gravis (autoimmune neuromuscular disorder that leads to fluctuating muscle weakness and fatigue), myotonic dystrophy ( is a chronic inherited multisystemic disease), ocular myopathy, simple congenital ptosis, blepharophimosis (bilateral ptosis) syndrome.
  3. Aponeurotic ptosis : This may be involutional (attachments of the muscle to the eyelid degenerate) or post-operative.
  4. Mechanical ptosis : This condition occurs due to the edema or tumors of eye lids.
  5. Neurotoxic ptosis : This type of ptosis occurs due to the exposure to snake venoms like cobras or kraits. This condition require immediate medical attention and often leads to respiratory failure, suffocation and death.

Diagnosis of ptosis : Ptosis primarily diagnosed by physical examination, these are as follows :

Slit-lamp examination : In this procedure a low-power microscope combined with a high-intensity light source is used to examine the eyelids, cornea, conjunctiva, sclera, and iris.

Test for myasthenia gravis

Visual field testing : This test is performed to see the total area in which objects can be seen by the patient in the peripheral vision while he or she focus his or her eyes on a central point.

Treatment :

Non surgical procedure : Non-surgical procedures include the use of “crutch” glasses or special Scleral contact lenses to support the eyelid.

Surgical : Eyelid lift surgery or blepharoplasty like Levator resection, Muller muscle resection and Frontalis sling operation is done to repair sagging or drooping upper eyelids.