Ptosis

Under one PtosisAlso known as ptosis, medical professionals understand a visible drooping of one or both upper eyelids. Basically, ptosis is just a symptom and can have various causes. It can either resolve itself when the cause is treated, or it may require surgical correction.

What is Ptosis?

Ptosis, also known as ptosis, describes a usually clearly visible lowering of one or both upper eyelids.

This can be completely or only partially and in some cases can impair the person's vision. Basically, the sinking of other organs or body parts such as the female breast can also be referred to by the term ptosis.

However, the word has been used primarily for lowering the upper eyelids. When the lower limbs droop, this condition is called ectropion. Ptosis itself is not a disease, just a symptom and can therefore have very different causes.

causes

The reasons for ptosis of the eyelids can be, for example, a congenital malformation of the muscle that is responsible for the movement of the eyelids (this is called levator in technical terms).

Such damage is hereditary and usually only affects one eye, i.e. only one eye. The levator can also be damaged by advanced age or violence in the area of ​​the eyes to the extent that the upper lid can no longer be lifted completely. Not only the levator itself, but also the corresponding nerve can be damaged and thus cause ptosis.

In this case, the lowering of the eyelid is usually also associated with a visible squint. Certain muscle disorders such as myasthenia gravis can also cause temporary ptosis to develop.

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Diseases with this symptom

• stroke
• Myotonic dystrophy

• Encephalitis
• Myasthenia gravis pseudoparalytica

• Meningitis
• Miosis

Diagnosis & course

Ptosis can usually be diagnosed by the attending physician without much effort, as it is visible at first glance. More emphasis should be placed on determining the root cause of the eyelid sagging.

Blood tests can reveal whether you have been poisoned. Tumors or other damage to the muscles or nerves involved can be made visible with the aid of computed tomography. The doctor can also use a muscle function test to determine whether and to what extent the levator is damaged.

The ptosis itself does not pose a threat to the health of the person concerned; however, the untreated course of certain underlying diseases that are accompanied by ptosis can in certain circumstances become life-threatening.

Complications

The drooping of one or both upper eyelids is very disfiguring. In everyday life, this asymmetry between the eyelids often leads to psychological stress. The person concerned withdraws more and more from the public, in some cases develops signs of depression up to and including depression.

Congenital ptosis is usually recognized early. However, if this is not the case, there are further complications. This leads to amblyopia, which is known as poor eyesight. In order to prevent this danger, it is essential to consult an ophthalmologist, especially if you have ametropia or strabismus in childhood.

In the case of ptosis, surgery under local or general anesthesia is often necessary. This can lead to nerve injuries, bleeding and infections. Furthermore, wound healing disorders and scarring are possible. Despite the generally good prognosis, the effect is sometimes too weak immediately after the operation (undercorrection).

Ptosis is still present. If the effect is too strong, the eyelid can no longer be closed. The eye dries out and allows ulcers to develop in the cornea. In both cases, further surgery is necessary.

Ptoris itself does not pose a health risk for the person affected. However, if this remains untreated in the further course, the development of certain underlying diseases can assume a life-threatening condition.

When should you go to the doctor?

If the eyelid suddenly begins to droop, the emergency services should be contacted immediately. The symptoms could be a stroke. Even if the eyelid begins to droop, a doctor should investigate the cause. The first way leads either directly to the ophthalmologist or to the family doctor, who usually issues a referral. Due to the many different forms of ptosis, a visit to the doctor makes sense in order to get a quick and professional examination and care.

Prevention of ptosis is not possible because the ptosis is always due to other underlying diseases or there is general damage to the eyelid muscle. This means that it is only ever possible to examine what triggered the ptosis. To counteract the adverse effects of ptosis, homeopathy offers various solutions. In the case of congenital ptosis, too, the surgical intervention should be carried out as early as possible (around the age of 3) in order to give the eye the opportunity to correct the visual performance.

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Treatment & Therapy

How exactly ptosis is treated depends primarily on the cause that is responsible for the lowering of the eyelid. Congenital ptosis can only be corrected with a surgical procedure that corrects the eyelid and shortens the muscle, for example. This prevents it from hanging down.

Such a surgical correction is necessary even if the levator is irreparably damaged by other causes. Under certain circumstances, an operation on the eyelid can result in the eye no longer being able to be completely closed. This can cause discomfort, especially at night. Then eye drops must be used regularly to prevent the eyes from drying out.

If the ptosis is due to a tumor disease, it is treated with appropriate chemotherapy. Surgical intervention to remove the tumor can also take place here. Myasthenia gravis can be treated with medication so that the symptoms subside completely and the ptosis also regresses on its own. The latter is always the case when there is no permanent damage to the muscles or nerves (yet).

Outlook & forecast

With ptosis, the prognosis is usually positive. If the symptom is congenital, it is usually sufficient to surgically lift the drooping upper eyelid. With an acquired symptom, the prognosis depends on the cause. If there is a serious illness such as myasthenia gravis, the malocclusion of the eyelid may resolve on its own. After a few months, the ptosis can then be treated surgically, provided that the underlying disease has completely healed. In mild cases, so-called ptosis glasses, which lift the drooping eyelid, are sufficient for treatment.

The prognosis is worse for ptosis that is due to a stroke. While the eyelid can be surgically repositioned, other symptoms that accompany the stroke can make the prospect of full recovery worse. Even with ptosis, which occurs as a result of a nerve or muscle disease, the prognosis may be more negative; then, for example, when the underlying condition repeatedly leads to the drooping of one or both eyelids.

Due to the multitude of possible causes, the final prognosis for ptosis can only be made by a treating physician.

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prevention

Since ptosis is only a symptom and not an actual disease and may also be hereditary or age-related, prevention in the strict sense is not possible. If the first signs of ptosis show up, however, it is advisable to consult a doctor to determine the exact cause of the eyelid droop. Only in this way can any more serious underlying illnesses be excluded or treated appropriately at an early stage.

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Medical evaluation is recommended if ptosis is suspected. If the eyelid suddenly droops, the emergency services should be alerted because the symptoms may be caused by a stroke. Also, if the eyelid begins to droop, a doctor should clarify the cause.

At the same time, the affected eyelid can be temporarily fixed with special adhesive strips from the pharmacy. In addition, a diary should be kept in which it is noted, for example, when the symptom began and which factors exacerbate it. Other complaints and abnormalities should also be recorded. The Simpson test is recommended as a further self-measure. Those affected have to look straight up for about a minute. If the upper eyelid then slowly sinks, there is a very high probability of ptosis.

Until the operation, patients can wear so-called ptosis glasses, which lift the drooping eyelid and prevent the symptoms from progressing. In addition, the eyes and especially the affected eyelid should be spared until the surgical procedure. After the operation, it is sufficient to protect the eyelid and to cool it so that the surgical scar can heal.