What Causes Drooping Eyelids (Ptosis)?

Eyelid droopy (ptosis) is when the upper eyelid is positioned lower than normal, causing it to droop at a level that does not obstruct vision or blocks the pupil. People with ptosis usually apply to the hospital with complaints of visual impairment or cosmetic discomfort caused by sagging of the upper eyelids. Drooping lid may be unilateral or bilateral. The disorder in question may be congenital or may have emerged later. Rapid management of droopy eyelids is possible with diagnosis after appropriate evaluation and subsequent treatment.

What is Eyelid Droop?

A condition in which the eyelid obstructs part or all of the eye, which can lead to functional and cosmetic problems, is called droopy eyelid. In a patient in whom this diagnosis is suspected, the distance between the pupil and the eyelid is measured. When this distance is less than 2 mm, it can be said that there is eyelid ptosis. There is no single cause of ptosis. This condition, which has many different causes, can occur in adults and children.

Ptosis in Children

Valve ptosis in children is mostly congenital; However, more rarely, it may develop later. When it is congenital, it is called congenital ptosis in medical terms. This is most often caused by problems in our muscles that lift the lid. Congenital ptosis may be accompanied by other problems. Some of these are:

• Problems with eye movement
• Muscle diseases
• Tumors on the eyelid or elsewhere (If it is above the eyelid, (may affect the muscles.)

In addition, the continuation of this condition in children may also pave the way for some problems that may arise later:

• The cover is so large that it blocks the child's vision. If it falls, it may cause amblyopia (amblyobia). In other words, the child may start to see worse in one eye than the other.
• Long-term blurred vision may increase the risk of astigmatism.
• This may sometimes cause strabismus.

Ptosis in Adults

Ptosis in adults is often not congenital; Because congenital valve ptosis is most likely noticed before adulthood. The problem of drooping valves in adulthood is mostly caused by injuries such as aging or trauma. It may also occur as a side effect after some eye surgeries. Rarely, some diseases or tumors may affect the valve muscle, causing valve ptosis.

Symptoms of Droopy Eyelids

The main symptom is drooping/sagging of one or both eyelids. When eyelid ptosis causes symptoms, the patient usually does not complain of pain. For this reason, in cases where there is pain, it would be better to turn to other diagnoses. Ptosis is a condition that can cause cosmetic problems or obstruct your vision. Since vision is affected especially in children with this disorder, the child may throw his head back and frequently lift his chin up in order to see better. Sometimes this symptom can also be seen in adults. People who have this problem may have to raise their eyebrows to open their eyes if they experience drooping due to a problem caused by the muscle that lifts the lid. Over time, these movements can affect the muscles in the head, neck and face.

If children have ptosis, amblyopia, or lazy eye, may have developed. Looking at the folds of the eyelids can help in early diagnosis, even before the symptoms in question appear clearly in children. If both eyelid folds are not symmetrical, it may be a sign of drooping eyelid.

What are the Causes of Eyelid Drooping (Ptosis)?

The answer to the question of what causes droopy eyelids is often wondered by patients suffering from this disorder. Sometimes it may seem like you have ptosis even if you don't actually have it. The presence of a drooping lid, even though there is no organic problem for various reasons, is called pseudodroopy lid. For diagnosis, it is important to first distinguish drooping valve from pseudo-drooping valve. Eyelid ptosis, which affects eye health in many aspects, can be congenital or acquired. The causes of non-congenital droopy eyelids can be grouped as follows:

1. Neurogenic: Neurogenic as a result of problems in the nerves that stimulate the muscle responsible for moving the upper eyelid (levator muscle). Valve ptosis may occur. For example, diseases such as Horner syndrome and multiple sclerosis (MS), which can cause third nerve paralysis, which is one of the nerves coming out of the brain, can cause this.
2. Myogenic cause: In the muscle responsible for lifting the valve up (levator muscle). A defect that may occur (myopathy) or defects where the nerve cells responsible for stimulating the muscle meet this muscle (neuromuscular junction), diseases such as Myasthenia Gravis may cause this.
3. Mechanical cause: Cancer tissue, scars, contact lenses, etc. that may appear on the upper part of the lid. The function of the muscle that lifts the lid up is impaired due to the mass effect of external structures that we do not expect to be there under normal conditions.
4. Aponeurotic cause: It occurs due to aging, trauma or side effects after a surgery. These are ptosis caused by problems in the tendons of the muscle that lifts the lid up. It is also known as involutional ptosis in medical language.
5. Traumatic cause: Cutting, tearing, etc. of the levator muscle in the valve after trauma caused by external factors. These are drooping valves that occur due to various reasons.

Specialist doctors use droopy eyelid surgery to treat ptosis in children. may suggest. This can be done in different ways, such as shortening the muscle that lifts the lid, connecting that muscle to other muscles that can help lift the lid. The primary goal of treatment is to correct vision. If the child has amblyopia due to ptosis, this condition is also treated. Amblyopia can be treated by wearing a band designed to strengthen the weak side, using special glasses, or using various drops. Do not forget to make an appointment for an examination for your child who has or is suspected of having droopy eyelids. You can consult your specialist doctor about how often your child should have vision examinations. Children should be carefully monitored for eye health because the structures related to their vision are constantly growing and changing shape.

Treatment of Droopy Eyelids in Adults

Your specialist doctor will definitely find the cause of the drooping valve before deciding on the treatment you need. Complete vision examination, blood tests and imaging tests; It is important to find the cause of this condition in adults. Your specialist ophthalmologist may recommend surgery to help the muscle that lifts the eyelid up work better. There are also new generation drops that can be used to treat some adults suffering from acquired ptosis. These medications, which are available with a prescription, act on the muscles that lift the lid. In adults with non-congenital ptosis, the valve opens wider after using the drops. However, for this drop to work, it must be used every day, and it may not work for every non-congenital ptosis. Therefore, you can get information by consulting your doctor whether this drop is suitable for your situation.

In some cases of drooping valves, surgery may also be recommended for adult patients. The surgery is done as an outpatient procedure and not as a major procedure. This means that you can return home immediately after surgery. During surgery, anesthesia is used only to numb the affected area and the area around it. This is called local anesthesia. After local anesthesia, sometimes only a small adjustment can be made to the muscle that lifts the lid and the surgery can be completed. Sometimes, in cases of severe valve ptosis, the levator muscle may need to be strengthened or even reattached to the valve. As with every surgery, droopy eyelid surgery also has possible risks and complications that may arise during the surgery. You can ask your specialist doctor to inform you about this issue and all your other questions about ptosis.