From the Guidelines
Ptosis palpebral should be treated based on its severity and cause, with surgical correction typically recommended for severe cases that affect vision or cause cosmetic concerns, as stated in the adult strabismus preferred practice pattern 1.
Causes and Diagnosis
The causes of ptosis can be congenital, age-related (aponeurotic), neurological, or due to muscle diseases like myasthenia gravis. A comprehensive eye examination is essential to determine the cause of ptosis, which may include a detailed medical and ocular history, sensorimotor exam, and evaluation of ptosis and anisocoria 1.
- The examination should also include a fundus examination to evaluate for the presence of papilledema or optic atrophy.
- The Ice Test or a rest test can be used to aid in diagnosis, particularly in cases of myasthenia gravis 1.
- Tensilon (edrophonium) testing may be considered, but it should be performed by an experienced practitioner in a monitored setting 1.
Treatment Options
Treatment options for ptosis depend on the severity and cause of the condition.
- For mild cases, no treatment may be necessary.
- For more severe cases, surgical correction is typically recommended, with the main surgical approaches including levator resection or frontalis sling procedures 1.
- Medical treatment of the underlying condition, such as myasthenia gravis, may improve ptosis, with medications like pyridostigmine or immunosuppressants 1.
- Temporary measures, such as ptosis crutches attached to eyeglasses or special tape to hold the eyelid up, can be used to manage ptosis while awaiting definitive treatment 1.
Importance of Early Treatment
Early treatment of ptosis is crucial, especially in children, as it can lead to amblyopia (lazy eye) if left untreated during visual development.
- Children with ptosis should be monitored closely, and treatment should be initiated promptly to prevent long-term vision problems 1.
- In adults, ptosis can also cause significant cosmetic concerns and affect vision, making prompt treatment essential to improve quality of life 1.
From the Research
Definition and Classification of Ptosis
- Ptosis is defined as an abnormally low-lying upper eyelid margin on the primary gaze, generally resulting from a congenital or acquired abnormality of the nerves or muscles that control the eyelid 2.
- Ptosis can be classified based on the onset time or etiology, and the clinical characteristics of congenital and acquired ptosis differ 2.
- Ptosis can be present at birth (congenital) or develop later in life (acquired) 3.
Causes and Symptoms of Ptosis
- Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical, or traumatic cause 3.
- Patients with ptosis complain about tired appearance, blurred vision, and increased tearing 3.
- Ptosis can affect one or both eyes and may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections 3.
Diagnosis and Treatment of Ptosis
- Diagnostic algorithms, plus management and referral guidelines, are essential in the comprehensive eye examination 4.
- Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities 3.
- Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery 3.
- Surgical techniques, such as Müller's muscle conjunctival resection, the Fasanella Servat procedure, shortening of the levator palpebrae, or levator muscle advancement, are proposed based on the degree of ptosis and levator function 3, 5.
Complications and Prognosis of Ptosis
- Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision 3.
- Immediately after surgery, there may be temporary difficulties in completely closing the eye, and full eyelid movement may not return in some cases 3.
- Optimal surgical timing and proper method are critical for avoiding the risk of potentially severe outcomes from ptosis and minimizing surgical complications 2.