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Ptosis- Upper eyelid drooping

Ptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. When the edge of the upper eyelid falls, it may block the upper field of your vision. Ptosis that is present at birth is called congenital ptosis.

Symptoms of ptosis include a decreased ability to keep your eyes open, eyestrain and eyebrow fatigue from the increased effort needed to raise your eyelids, and fatigue, especially when reading.

In severe cases, it may be necessary to tilt your head back or lift the eyelid with a finger in order to see out from under the drooping eyelid(s). You may also notice that you have a tired appearance from "droopy eyelids" even though you are well rested.

Causes of Acquired Ptosis

Acquired ptosis is most commonly due to stretching of the levator muscle in the eyelid. The levator muscle is the major muscle responsible for elevating the upper eyelid. Another cause of acquired ptosis is interference with the nerve supply to the muscle. Acquired ptosis may occur as a result of aging, trauma, or muscular or neurologic disease.

As you get older, the tendon that attaches the levator muscle to the eyelid stretches and the eyelid may fall, covering part of the eye. It is not uncommon for a patient to develop upper eyelid ptosis after cataract surgery, which can sometimes cause the weak tendon to stretch.

Acquired ptosis can also be caused by injury to the oculomotor nerve (the nerve that stimulates the levator muscle), or following severe trauma to the eye's orbit that injures the tendon connecting the levator muscle to the eyelid.

Acquired ptosis may also be the first sign of myasthenia gravis, a disorder in which the body’s muscles become weak and tire easily. Ptosis is also present in people with Horner's Syndrome, a neurologic condition that affects one side of the face and indicates injury to part of the sympathetic nervous system.

Causes of Congenital Ptosis

While the cause of congenital ptosis is often unclear, the most common reason is improper development of the levator muscle.

Treatment of Ptosis

Acquired ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. Surgery is designed to reattach the stretched muscle to its normal location. If there is poor strength in the levator muscle, a "sling" may be used to enable the forehead muscles to elevate the eyelid.

If congenital ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age. However, when the ptosis interferes with the child's vision, surgery is performed at an earlier age to allow proper visual development.

The main goals of ptosis surgery are elevation of the upper eyelid to restore normal field of vision and an attempt to achieve symmetry with the opposite upper eyelid. These goals depend on many factors and, therefore, may not always be possible to achieve.

Surgery is usually performed with local anesthesia, which numbs the upper eyelid, and with the patient lightly sedated with oral and/or intravenous medications. Some surgeons prefer to use general anesthesia, in which case the patient will sleep through the operation.

Entropion

Entropion is the medical term used to describe a condition where the lower eyelid and eyelashes turn or roll inward towards the eye. This causes the eyelid and its lashes to constantly rub against the cornea (the front part of the eye) and conjunctiva (the mucous membrane that protects the eye).

Causes of Entropion

Entropion is usually due to relaxing of the tissues of the eyelid as a result of aging changes, Thus, it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid to turn inward. Entropies may also be caused by inflammation or scarring on the inner surface. Sometimes, entropion is present at birth (congenital) if the eyelids are not formed normally.

Symptoms

Entropion can cause chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting on the eyelid and mucus discharge, a feeling that something is in your eye, irritation of the cornea, and impaired vision.

Damage to the cornea (the clear part of the eye), including infection and scarring, may develop due to the chronically turned in eyelid. These are important reasons for having this condition repaired before permanent damage occurs to the eyes.

Treatment

The usual management for entropion involves tightening of the eyelid and its attachments to restore some of its elasticity and to reposition it normally. There are a number of surgical techniques for successfully managing an entropion and each surgeon will have a preferred method.

If a patient is not able to undergo surgery, tape or sutures can be used to temporarily reposition the eyelid and to protect the eye. Lubricating drops and ointments for the eye are also helpful on a temporary basis.

Entropion seen in babies usually resolves spontaneously within a few months, but occasionally needs to be treated.

When other factors contribute to the presence of an entropion, they may require special treatment. Medications are frequently used to control inflammation or infection of the eyelid and to treat scars. Scar excision and tissue grafts may also occasionally be necessary.

Ectropion

Ectropion is the medical term used to describe an abnormal lower eyelid that turns outward and no longer touches the eye. As a result, the conjunctiva (the mucous membrane that lines the eyelid) may become red and exposed. This condition usually involves one or both lower eyelids but, rarely, may affect the upper eyelid(s).

Causes of Ectropion

Ectropion is usually due to relaxing of the tissues of the eyelid as a result of aging changes. Thus, it is most often seen in elderly people who develop stretching of the structures supporting the lower eyelid. It can also arise as a result of undetected skin cancers pulling down the eyelid, trauma, contraction of scar tissue( (from wounds, burns, or surgery) involving the skin surrounding the lower eyelid, and following eyelid or facial surgery.

Ectropion may develop following facial nerve palsy (Bells Palsy), in which the muscles surrounding the eye (and other facial muscles on the side of the face) are paralyzed. Finally, ectropion may be further aggravated due to constant wiping of excessive tearing, which tends to pull the eyelid further from the eye.

Symptoms

Ectropion can cause chronic irritation to the eyelid and the eye. This can result in excessive tearing, crusting of the eyelid and mucus discharge, infection, irritation of the cornea (the front part of the eye), and impaired vision. When the lower eyelid is turned outward and no longer touches the eye, it cannot properly spread the tear film across the eye which leads to poor drainage of tears through the nasolacrimal (tear drainage) system. The exposed inner lining of the eyelid becomes dry and inflamed. As a result the eye may become damaged.

Treatment

To prevent dryness of the cornea because the tear film does not properly lubricate the eye, artificial tears and lubricating ointments may be used to keep the cornea moistened. A protective shield may be worn at night to keep the moisture in the eye. If the ectropion is due to laxity of the eyelids supporting structures, it is best treated surgically. Depending on the cause, surgery can reposition the eyelid back to its normal position against the eye. This can be accomplished by tightening the eyelid and its attachments to restore some of its elasticity and to reposition the eyelid. The surgical procedures are usually performed on an out patient basis using a local anesthetic. If the ectropion is a result of scaring, skin cancer, trauma, facial nerve palsy, or some other factor, treatment of the underlying condition may be done before or at the same time the ectropion is repaired.