What is Ptosis: Causes, Symptoms, Prevention and Treatment

Ptosis or drooping eye is where the upper eyelid droops slightly over the eye. It can partially limit or block the normal vision of the eye. It happens due to damage to the nerve that controls the eyelid muscles and their movement.

Congenital ptosis, present at birth, and Acquired ptosis, which occurs later in life, are two major categories that divide the various kinds of ptosis.

1. Congenital Ptosis:
   1. Due to improper levator muscle development in the womb, a kid with congenital ptosis is born with impaired or ineffective levator muscle function. Because of this, infants born with ptosis frequently have poor vision in their superior field of vision (the top portion of the field of vision) and may tilt their heads back to try to see clearly.
   2. These kids risk developing amblyopia or lazy eye if their visual issues are not addressed.
2. Acquired Ptosis: The five basic types of acquired ptosis might change over time. These consist of:
   1. Aponeurotic Ptosis: The most typical kind of ptosis is aponeurotic. The levator muscle of the eyelid is stretched out in this condition, which is typically brought on by age. The disorder may also be brought on by excessive eye rubbing or eyelid pulling brought on by eye irritation or prolonged contact lens wear.
   2. Neurogenic Ptosis: When there is a problem with the neural system regulating the eyelid muscles' movement, it results in neurogenic ptosis.
   3. Myogenic Ptosis: Levator muscle weakening related to a systemic condition (muscular dystrophy) is known as myogenic ptosis.
   4. Mechanical Ptosis: The eyelid is constricted due to an accumulation of skin or a mass.
   5. Traumatic Ptosis: This condition happens due to damage to the eyelid, either through an accident or another type of eye trauma. The levator muscle is compromised or becomes weaker by this injury.

One or both upper eyelids drooping is the primary symptom of ptosis. It may occasionally impair vision. However, many people discover that the eyelid sagging is either barely perceptible or irregular.

1. Ptosis results in extremely dry or watery eyes as the eyelids become unable to keep the eyes moist efficiently.
2. When the upper eyelid droops to the point where it covers the pupil, ptosis can hinder vision. Many people with severe ptosis tilt their necks back when they speak.
3. Tiredness and soreness around the eyes are additional symptoms of ptosis. It is because, to see clearly, people with ptosis keep lifting their eyebrows.

There are various causes of ptosis. Some newborns are born with ptosis in one or both eyelids. If the muscles or ligaments that typically elevate the eyelid are compromised by disease or injury, ptosis may develop later in life. Damage to the nerves that regulate the eyelid muscles can occasionally cause the eyelids to droop. Other reasons that can cause ptosis are:

1. Weakness or damage in the muscle responsible for raising the eyelid.
2. Loosening of the skin or damage to the nerves controlling muscle on the upper eyelids.
3. The normal ageing process loosens and weakens the upper eyelid’s skin muscles.
4. One might be born with ptosis.
5. Eyelids can also be stretched through surgery such as LASIK or cataract surgery, leading to ptosis.
6. Eye tumour.
7. Various diseases such as diabetes, horner syndrome, and myasthenia gravis.

Ptosis is more likely to occur in people with eye tumours, diabetes, a history of stroke, cancer, and neurological conditions. The following are some possible ptosis risk factors that could increase the chances of contracting the illness:

1. Medical Conditions 
   1. Drooping eyelids may indicate an underlying medical disease, particularly if both eyelids are affected.
   2. Cosmetic treatments like Botox can also lead to ptosis.
2. Critical Conditions
   1. Droopy eyelids can occasionally signify more severe illnesses, including a brain tumour, stroke, or cancer of the muscles or nerves.
   2. Ptosis can also result from neurological conditions that affect the nerves or muscles of the eyes, such as Myasthenia Gravis (A weakening and fast tiredness of the muscles.)

It is impossible to prevent ptosis. An individual can fight the illness by being aware of the symptoms and undergoing routine eye exams. Take ptosis seriously because it can impair vision. Visiting a doctor as soon as possible might help prevent it from worsening.

The doctor will probably examine the patient physically and inquire about his/her medical background. The doctor will do a complete physical examination to carefully examine the eyes to confirm the extent of the drooping. 

1. The doctor will prescribe some tests to investigate the number of times and the length of time the eyelid drooping has been happening.
2. Slit Examination: With a microscope having a highly intense light, the doctor can look closely at the eye. During this, the patient’s eyes may become dilated and may experience slight eye discomfort.
3. Tensilon test: This test involves injecting the Tensilon drug, generically known as edrophonium, into the patient’s veins. The doctor then asks them to cross and uncross their legs or stand up and sit down several times. The doctor investigates if the Tensilon improves the patient’s muscle strength by doing so.

How to prepare for the doctor's consultation?

1. List down symptoms including any that may seem unrelated to the condition.
2. List down the relevant events that may be related to the condition.
3. The patient must tell the doctor the list of medications and supplements that he takes.
4. The following questions should be asked the doctor:
   1. What treatment is best suitable for me?
   2. How can I stay comfortable in this condition?
   3. Do you think I have any other conditions?
   4. Do I need to see a specialist for my condition?
   5. Do I need surgery for this condition?

The ptosis treatment depends on the condition's specific cause and severity. The doctor may advise doing nothing if the condition is associated with ageing or congenital disease because it isn't usually detrimental to the patient's health. However, the patient can opt for plastic surgery due to cosmetic dissatisfaction. If the doctor finds that an underlying condition is the source of drooping eyelids, the patient will be treated to stop the eyelids from sagging. If the ptosis blocks the vision, the doctor may recommend surgery.

Ptosis treatment without surgery

Treatment of ptosis involves specially designed glasses to hold the eyelid up, known as Ptosis Crutch. This treatment is generally advised only when the condition is temporary, or the patient is not a good candidate for surgery.

1. The ptosis crutch is a non-surgical treatment that involves installing an attachment to the spectacles frames to support the eyelid and prevent eye drooping.
2. Ptosis crutches come in two varieties: adjustable and strengthened; adjustable ones are attached to one side of the frames, while reinforced ones are attached to both sides.
3. Crutches can be attached to almost any eyeglass frame, but metal frames work best. If a patient wants to use a crutch, he/she can go to an ophthalmologist or a plastic surgeon specialising in ptosis.

Ptosis treatment with surgery

The weakening of the levator muscles (the muscle that elevates the eyelid) is the most frequent cause of ptosis. Levator muscle tightening, therefore, takes place during ptosis surgery. When the levator muscles are insufficient to support the eyelids, the eyelids are suspended beneath the eyelids and supported by the forehead muscles.

1. Under local anaesthesia, ptosis surgery is typically done as an outpatient treatment.
2. Depending on the repair that needs to be made, the procedure could last 45 to 90 minutes. If both eyelids need to be corrected, the surgery will take longer.
3. Typically, an incision is made along the eyelid's natural crease. The levator muscles are then stitched to reinforce their connection to the eyelid.
4. It's important to understand that complete restoration is not possible in case of muscle weakness. Therefore, while ptosis surgery will enhance eyelid functionality, it could not quite fully recover it.

Cases of ptosis may run in families. An individual may be more susceptible to developing ptosis if a family member already has it. Ptosis can prevent vision from developing properly. The degree of eyelid droop is connected to the complications of ptosis. Some typical dangers of ptosis include:

1. Amblyopia (decreased eyesight due to abnormal visual development)
2. Vision distortion
3. Headaches
4. Scars
5. The eyelids have wrinkles

When to see a doctor?

The patient can consult the doctor if he/she experiences:

1. Tiredness 
2. Soreness
3. Dry and watery eyes

Healthy, whole foods can contribute to better eye health, but they cannot help treat the condition. Below mentioned are some of the dietary habits one can keep in mind for better eye health.

1. Eat healthy protein-rich food
2. Use supplements like vitamin A, C, B12 or lutein
3. Food items rich in omega-3 fatty acid