From the Guidelines
Ptosis is normally treated with surgical correction, which is the definitive treatment for most cases, aiming to improve morbidity, mortality, and quality of life by enhancing vision and reducing associated complications. Treatment options for ptosis (drooping of the upper eyelid) include both non-surgical and surgical approaches depending on the severity and cause. For temporary or mild ptosis, special ptosis crutches attached to eyeglasses can physically hold the eyelid up. However, according to the most recent and highest quality study available, 1, surgical management is often necessary, especially in cases of complete ptosis, where patients may experience diplopia until their lid is elevated.
The main surgical options include levator advancement or resection (for good levator function), frontalis sling procedures (for poor levator function), and Müller's muscle conjunctival resection. These procedures aim to strengthen or reattach the levator muscle that raises the eyelid. The choice of surgery depends on the degree of ptosis, the patient's levator muscle function, and the underlying cause, as highlighted in the study 1. Children with congenital ptosis may need prompt surgical intervention to prevent amblyopia (vision loss). Recovery from ptosis surgery typically takes 1-2 weeks, with swelling and bruising gradually subsiding. Potential complications include under or overcorrection, asymmetry, dry eyes, and exposure keratopathy, making proper patient selection and surgical technique crucial for optimal outcomes.
Some key considerations in the management of ptosis, as noted in the study 1, include the importance of addressing the cause of the ptosis, managing diplopia, and considering the use of prisms, botulinum toxin, or occlusion as temporary measures. However, surgical correction remains the primary treatment for achieving long-term improvement in ptosis, thereby reducing morbidity and enhancing quality of life. It is essential to weigh the benefits and risks of each treatment option and to individualize the approach based on the patient's specific condition and needs, always prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the Research
Treatment Options for Ptosis
- The treatment of ptosis depends on various factors, including age, etiology, severity of ptosis, levator function, and presence of additional ophthalmologic or neurologic abnormalities 2.
- Treatment options for ptosis include a watch-and-wait policy, prosthesis, medication, or surgery 2.
- For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed 2.
- For moderate ptosis with a levator function of 5-10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed 2.
- For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated 2.
Medical Management of Ptosis
- Topical 0.5% apraclonidine solution can be used to evaluate and treat blepharoptosis, and may be as effective as topical 2.5% phenylephrine in elevating a ptotic upper eyelid 3.
- Apraclonidine eyedrops can be used to treat ptosis after the administration of botulinum toxin to the upper face 4.
- Apraclonidine has been shown to be effective in treating botulinum toxin-induced ptosis, with improvement in ptosis observed in all patients treated with apraclonidine 0.5% solution 5.
Surgical Management of Ptosis
- Surgical treatment of ptosis carries risks, including infection, bleeding, over- or undercorrection, and reduced vision 2.
- Immediately after surgery, there may be temporary difficulties in completely closing the eye, and the eyelids may not appear perfectly symmetrical 2.
- In rare cases, full eyelid movement does not return, and more than one operation may be required 2.