Ptosis

Definition

Ptosis is also called "drooping eyelid." It is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control those muscles, or looseness of the skin of the upper eyelids.

Alternative Names

Drooping eyelids

Causes, incidence, and risk factors

Drooping eyelid can be caused by the normal aging process, a congenital abnormality (present before birth), or the result of an injury or disease.

Risk factors include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, and a brain tumor or other cancer, which can affect nerve or muscle reactions.

Symptoms

• Drooping of one or both eyelids
• Increased tearing
• If ptosis is severe, interference with vision.

Signs and tests

• A physical examination to determine the cause
• Special tests may be done to evaluate suspected causes, such as myasthenia gravis

Treatment

If an underlying disease is found, the treatment will be specific to that disease. Most cases of ptosis are associated with aging and there is no disease involved.

Surgery can be done to improve the appearance of the eyelids in milder cases if the patient wants it. In more severe cases, surgery may be necessary to correct interference with vision. In children with ptosis, surgery may be necessary to prevent amblyopia.

Expectations (prognosis)

The expected outcome depends on the cause of the ptosis. Surgery is usually very successful in restoring appearance and function.

Complications

If a drooping eyelid is left uncorrected in a child, it can lead to lazy eye.

Calling your health care provider

Drooping eyelids in children require prompt evaluation by an ophthalmologist.

New or rapidly changing ptosis in adults requires prompt evaluation by an ophthalmologist.

References

Custer PL. Blepharoptosis. In: Yanoff M, Duker JS, Augsburger JJ, Azar DT, eds. Ophthalmology. 2nd ed. Philadelphia, PA: Mosby Elsevier; 2004: sect 2, chap 86.

Olitsky SE, Hug D, Smith LP. Abnormalities of the Lids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 623.