In medicine, ptosis (also known as blepharoptosis) is usually understood to be the drooping of the upper eyelid (eyelid drooping). The affected person is unable to open the eye fully by lifting the upper eyelid. Ptosis can occur unilaterally or bilaterally - unilateral (unilateral) ptosis is, however, the rule.
You can find out which doctor treats ptosis and what the therapy looks like below.
Typical for ptosis is that the patient can only lift the affected eyelid partially or not at all with difficulty.
Ptosis can be mild to severe. Its effects range
Ptosis is particularly problematic if it largely or completely closes the affected eye. If children are affected by such ptosis, the vision of the forcibly closed eye cannot develop. Ptosis then absolutely requires treatment.
Once missed, this development cannot be made up for later. The eye can then no longer develop functional vision (amblyopia).
Ptosis: The affected eyelid hangs down further than usual and the eye can only be opened fully with difficulty © Angelina | AdobeStock
Ptosis usually has neuromuscular causes: Either there is a problem with the muscles that mediate the movement of the eyelids. Or the nerves that control the muscles are not transmitting the impulses correctly.
The levator palpebrae superioris muscle ( levator for short) is responsible for raising and lowering the eyelids. The nerve controlling the levator muscle is the oculomotor nerve. The superior tarsalis muscle(Müller muscle), which pulls the raised eyelid together vertically like a roller blind, is also involved in holding the eye open.
The following causes and manifestations of ptosis are possible:
Long-term wear of rigid contact lenses could also be a risk factor. A connection between acquired, non-age-related ptosis and contact lens wear is well documented. Researchers are discussing the mechanical "wearing out" of the levator muscle due to the manual lifting of the eyelids when removing contact lenses. However, there is still no clarity on this point.
Eyelid closure triggered by mechanical causes can also be described as ptosis. This can be caused, for example, by
happen.
Pseudoptosis is when the eyelid drooping is anatomically caused. Pseudoptosis can occur due to a lack of support for the eyelid caused by a shrunken or missing eyeball. However, it can also be caused by age-related loss of skin tension in the eyelid.
An asymmetry in the size and attachment of both eyelids can give the appearance of ptosis.
Ptosis is easy to diagnose due to its characteristic appearance. The doctor examines the eye for
He will also test the pupillary reflex and the mobility of the eyeball in order to narrow down the possible causes of ptosis.
It is important to differentiate diagnostically between
The treatment of ptosis depends on its cause or form.
If the cause is an underlying neuromuscular disease or intoxication, medication/antidotes are possible. These can be used to treat the underlying disease - if treatment is available. If the underlying disease is cured, the ptosis also disappears.
Congenital, injury- or age-related ptosis can be corrected surgically if it impairs vision.
The correction of mild ptosis for purely cosmetic reasons also makes sense. However, health insurance companies do not usually cover this procedure. The surgical procedure is performed by a plastic and reconstructive surgeon who specializes in the eye area.
The following options are available:
There are also mechanical aids that keep the eyelid open if surgical correction is not an option. Ptosis spectacles have one or two horizontal arms on the frame above the lenses, which are clamped under the eyelids. Ptosis glasses are custom-made by specialized opticians, as the position, shape and length of the temples must be precisely adjusted.
Without surgical correction or healing of the underlying disease , ptosis will not disappear on its own. If neither is possible, those affected must come to terms with the diagnosis, for example by wearing ptosis glasses.
The results of ptosis surgery are generally very good. However, complications can occur in rare cases:
Standard operations achieve a completely satisfactory result in around 80 percent of cases during the first procedure. A follow-up operation can usually correct an unsatisfactory result.
In cases of congenital ptosis, the success rate of frontalis suspension is over 90 percent. The same applies to the success rates for surgical shortening of the Müller muscle.
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