DISEASES AND TREATMENTS

Eyelid ptosis or droopy eyelids

What is ptosis?

The term ptosis refers to the drop or displacement of an organ. Eyelid ptosis, blepharoptosis or droopy eyelids are ophthalmological terms used to talk about the drooping of the upper eyelid. It can occur in adults as well as children in one or both eyes. If it occurs in children, it is usually a congenital problem. It is one of the most common oculoplastic conditions.

Causes

It is normally produced by a “de novo” alteration, without genetic alteration, although in some cases the origin may be genetic, as in blepharophimosis syndrome.

Types of ptosis

• Aponeurotic ptosis: It is the most common one. It occurs because the eyelid tissues age and the levator muscle becomes loose, causing the eyelid to droop.
• Neurogenic ptosis: This anomaly is characterised by lack of nerve stimulation in the muscle. It usually occurs in children (Marcus Gunn syndrome)
• Mechanical ptosis: It occurs when there is a cyst or tumour in the upper eyelid causing a “mechanical” drop.
• Myogenic ptosis:The levator muscle of the upper eyelid does not perform its function well, which means that the eyelid is not in its normal position.

Symptoms

There are different symptoms associated with ptosis:

• The upper eyelid drops and partially or completely covers the eye.
• Visual field reduction
• The need to tilt the head back or even lift the eyelid with the finger to be able to see.
• Asymmetries in the position of one eyelid with respect to the other

Diagnosis

The cause and the appropriate treatment can be determined by evaluating data from the medical history, such as the time and mode of appearance of the problem, signs and symptoms. Next, the muscle function that is responsible for lifting the eyelid should also be analysed. Depending on whether the function is good, poor or bad, a surgical approach or other treatment will be indicated.

In the case of children, it is important to determine whether they have other vision problems, such as amblyopia (lazy eye), in which case immediate surgery is recommended.

Consequences

Eyelid ptosis has different consequences for the patient:

• Vision impairment, being able to generate vision alterations, such as lazy eye, also called amblyopia.
• Those affected by ptosis, especially children, experience bullying during childhood that affects later psychological development.

Treatments

Treatment, in most cases, is surgical. The goal of surgery is to resect the muscle that lifts the eyelid or, if the eyelid is not working and is completely immobile, to use the frontalis muscle as an accessory muscle.

Surgery

Correction of ptosis is recommended in all cases, since this is not an aesthetic problem. In children, if the eyelid covers the pupil, surgery should be performed as soon as possible to avoid visual development problems. Otherwise the surgery may be postponed to be performed before the child begins school age.

In adults, ptosis can affect the visual field and generates cervical problems over time, it can therefore be corrected as soon as the problem is detected.

Different techniques are used, grouped by anterior approach, posterior approach and frontalis suspension techniques, including the frontalis muscle flap.

In the case of children, two variants are used depending on whether or not the levator muscle has sufficient strength to move the eyelid. If it does have sufficient strength, the levator muscle is resected and when it does not, a frontalis suspension (the frontalis muscle is joined with the eyelid).

This can be done indirectly using materials such as silicone, autologous fascia lata, mersilene or threads, or directly.

The direct frontalis suspension or direct frontalis flap technique consists of connecting the forehead muscle with the eyelid directly through an incision that is concealed in the crease of the eyelid. This technique avoids the complications that can appear with other techniques generated by rejection of the autologous or heterologous materials used, as well as complications derived from the donation sites and scars on the forehead.

Surgery objectives

• Avoid new interventions.
• Ensuring that the incisions caused by the surgery are not seen.
• Make sure that no one can know that the person having the surgery has had congenital ptosis, which will achieve a happier life and avoid the psychological problems that may arise.
• As a surgeon, my objective is to ensure that it is not possible to distinguish which eye has been operated on.

Surgery process

Before the surgery

A complete eye and eyelid examination should be performed. You must inform us of the medications you are taking in case there may be any contraindications, for example aspirin or anticoagulants.

During the surgery

Ptosis surgery in adults is an outpatient process under local anaesthesia, in the case of children it is performed under general anaesthesia.

After the intervention

Postoperative treatment is simple, although you will need to care for it to avoid infections and chafing. Consultations are usually made the next day and one week after the intervention.

Prevention

Ptosis cannot be prevented but can be easily detected in the early stages. It is even possible to act before the visual field is affected and the unsightly effect it causes is very pronounced. Its correction prevents torticollis and neck pain and the discomfort frequently associated with this dysfunction.

Risks

Surgery always seeks symmetry between both eyelids, although in some cases more than one procedure is necessary. There is a risk of over or under-correction that can be corrected later.