Ptosis is a condition affecting the upper eyelids, making them incapable of maintaining normal elevation. Instead, the eyelid droops downward, thus the name droopy eyelid or dropping eye. There are several potential causes for acquired ptosis, including trauma to the eye, muscular problems, Horner’s syndrome, neurological problems, old age, nerve damage within the eye muscles, and more. It may affect both or one eye, and the sagging is not always noticeable.
Besides the sagging, people with ptosis may suffer from extremely dry or watery eyes. This is probably the only uncomfortable symptom you will experience with ptosis. The sagging does not cause pain, which is why many people never seek treatment for the condition. However, in extreme cases, it could negatively impact your vision and appearance. The eyelid may droop so low that it covers the eye and obstruct your vision. Due to the obstruction, you constantly find yourself raising the eyebrows in an attempt to pull the eyelids up. Over time, this tires the facial muscles, making you appear tired all the time.
Types of Acquired Ptosis
Unlike congenital ptosis, which is present at birth or develops within the first year of life, acquired ptosis develops later in life. It can affect adults of all ages, but increased age puts you at greater risk. There are five types of acquired ptosis that you can develop.
Aponeurotic Ptosis
This is the most popular form of ptosis. It affects the elderly due to overstretching of the levator muscles that occurs over several years. Rubbing the eyes or pulling the eyelid, maybe due to irritation or allergies, can also develop ptosis.
Neurogenic Ptosis
This type of ptosis occurs due to a lack of nerve stimulation in the muscles that control eyelid movement. It could be that the oculomotor or sympathetic nerve is damaged or dysfunctional, or the central nervous system is not functioning optimally. Neurological conditions such as Horner syndrome or third nerve palsy are often to blame for the nerve impairment. If it has been established that you are suffering ptosis due to an underlying condition, plans will be made to treat the condition and then the ptosis.
Myogenic Ptosis
Myogenic ptosis is caused when the levator muscle is not functioning correctly. This interferes with the normal position of the eyelid as the muscle is weakened, causing it to sag. Systemic disorders such as myasthenia gravis, mytonic dystrophy, and chronic external ophthalmoplegia are to blame
Traumatic Ptosis
As the name implies, this is ptosis that occurs due to trauma to the eyelid muscles. This could be caused by an accident or a blow to the eye. Trauma can cause injury to the levator muscle or a scar mat form around the muscle interfering with its optimal functioning.
Mechanical Ptosis
This happens when the levator muscles cannot lift the eyelid because it is too heavy. The weight could be caused by a tumor on the eyelid and puts pressure on the muscle. In most cases, surgery is necessary to correct the problem.
Risk Factors
As seen above, a variety of things contribute to you developing acquired ptosis. While for most people, it is a normal effect of aging, for others, it is a combination of factors which include:
History of eye tumors
Neurological disorders such as Horner’s syndrome
Habits that put pressure on the eyelid muscle like rubbing the eyes and the use of contact lenses
Having undergone eye surgery. The levator muscle may be damaged in the process, or a scar could form around it, interfering with how it works.
Cosmetic treatments like Botox injections
Diagnosis and Treatment
To determine if you have droopy eyes, an ophthalmologist will first examine your eyelids to look for signs of sagging. The height of your eyelids and the strength of the eyelid muscles will also be measured to see any abnormalities. If it is suspected that your eyes are drooping, a visual test will also be done to check if your vision is normal.
Once it has been confirmed you have ptosis, the next step is determining the best course of treatment. If the condition is not affecting your eyesight and you are an adult, treatment is unnecessary. However, if your vision is obstructed and you have to tilt your head to drive or read, you will have to undergo treatment.
Surgery is the most popular treatment for ptosis. It helps tighten the levator muscle and raise the eyelid. If there is excess skin on the eyelids, a blepharoplasty will be done along with the ptosis repair. Also, surgery can be done just to lift the eyebrows without repairing the levator muscle. This is a great way to get rid of the hang and, at the same time, improve appearance.
For a non-invasive method of treatment, Upneeq (oxymetazoline hydrochloride ophthalmic solution), which comes as eye drops, is recommended. Make sure to consult your doctor before starting any treatment to prevent further damage to the eye or the eyelids.
