Introduction

Ptosis is the condition of the eyelids that causes them to be displaced from their natural position. The eyelids fall down which cover the eyes and makes them look very droopy. In addition to eyelids the margins of the eyelids also tend to droop and this may cause the patient’s vision to be obstructed either partially or fully. Ptosis is quite a common ocular problem and in most cases it can be treated completely with surgery.

Various patients can have varying degree of ptosis. In some patients, presence of mild ptosis can cause the patients to make an effort to see things around them. Mild cases may be very evident and the patient may just feel extra strain on the eyes. In children presence of acquired or congenital ptosis may cause further problems if it is not treated in time. It may lead to the child’s vision to become progressively poor and may cause associated developmental abnormalities as well.

People who are suffering from ptosis may get affected by it both medically and cosmetically. Even though in some cases the ptosis may be mild it may affect the symmetry of the face. Therefore it is the surgery for ptosis is considered to be a cosmetic procedure as well. It may be done to correct the cosmetic aspect of the ptosis as well. For correction of ptosis a specialist should be consulted who can not only correct the problems in the vision but also restore the symmetry of the ocular area and optimize the features in accordance with each other.

Types of ptosis

Ptosis which is also known as Blepharoptosis, can be either congenital or acquired. Congenital ptosis is present in children from birth or some children acquire their condition within first few months of their life. Acquired ptosis is the ptosis which can occur in adults due to many reasons. One of the forms of acquired ptosis is Aponeurotic ptosis which typically occurs in older people. Aponeurotic ptosis is also known as senile ptosis or involutional ptosis. It is known as involutional ptosis as it is considered to be an involutional disorder. It is believed to happen due to detachment of the levator muscle from the tarsus. It is progressive and slowly acquired disorder as it causes slow loosening of levator muscles with age.

Causes of Aponeurotic ptosis

Though in most cases aponeurotic ptosis may be an acquired condition, there are some cases in which aponeurotic ptosis can be congenital also. The causes of congenital aponeurotic ptosis can be vacuum extraction, rotation fetus during delivery which may cause trauma to the fetus. In many patients, aponeurotic ptosis can occur after a surgery of cataract. Other causes may include inflammation of eyes, continuous use of contact lens and trauma. The degeneration of muscles in the case of Aponeurotic surgery may be natural or may be due to loss of fatty tissues in the Whitnail’s ligament.

Symptoms of Aponeurotic ptosis

The symptoms of aponeurotic ptosis can be varied. The patients may suffer from acute obstruction of vision. Or in some cases the symptom may include cosmetic asymmetry of eyelids. The symptoms become even worse when the patient is gazing down or reading. The patient may try to keep their head elevated or try to raise their eyebrows for ease of vision, but this may cause the patient to suffer from persistent fatigue.

Physical examination of Aponeurotic ptosis

The diagnosis or physical examination of aponeurotic ptosis begins with visual examination and observation of symptoms. The marginal reflex distance is also measured for checking the patient. The distance from the eyelid margin to the crease of the upper eyelid known as the upper eyelid crease position is measured. The normal vertical palpebral fissure height which is about 12- 15 mm in normal patients is also measured. This is the maximum distance between the upper and lower eyelid. Abnormalities of the pupil and other facial or ocular deformities are also observed in the patient. The elevation of chin, the resting position of eyebrows and the position of the head is also checked to assess the extent of aponeurotic ptosis. The diagnosis of the Aponeurotic ptosis is done with the eyelids of the patient in their natural state and with the eyelids taped in elevated position. This can give the surgeon an idea about the visual impairment of the eyes of the patient. A comparison of progression photographs of the patient before ptosis till the current condition can give an idea about the condition of the patient’s Aponeurotic ptosis.

Surgery

The surgery generally is done under local anesthesia and the detached levator muscle is attacked back to the tarsus. The most common complication is infection and under correction of the problem. In cases of under correction of Aponeurotic surgery a secondary surgery may be required.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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