Blepharoptosis

Blepharoptosis, commonly referred to as ptosis, is a condition characterized by the drooping of the upper eyelid. This condition can affect one or both eyes and can be present at birth (congenital) or develop later in life (acquired). Ptosis can vary in severity, from a slight droop to complete closure of the eyelid, potentially impairing vision.

Etiology

Blepharoptosis can be caused by a variety of factors, which can be broadly categorized into congenital and acquired causes.

Congenital Ptosis

Congenital ptosis is often due to developmental issues with the levator palpebrae superioris muscle, which is responsible for lifting the eyelid. It may be associated with:

• Congenital myopathies
• Marcus Gunn jaw-winking syndrome
• Blepharophimosis syndrome

Acquired Ptosis

Acquired ptosis can result from:

• Aponeurotic ptosis: Often age-related, due to stretching or dehiscence of the levator aponeurosis.
• Neurogenic ptosis: Caused by nerve dysfunction, such as in Horner's syndrome or third cranial nerve palsy.
• Myogenic ptosis: Due to muscle diseases like myasthenia gravis.
• Mechanical ptosis: Resulting from the weight of a mass or swelling on the eyelid.
• Traumatic ptosis: Following injury to the eyelid or surrounding structures.

Clinical Presentation

Patients with blepharoptosis may present with:

• Drooping of one or both upper eyelids
• Impaired vision if the droop covers the pupil
• Increased tearing
• Eye strain or fatigue
• Compensatory head posture, such as chin elevation, to improve vision

Diagnosis

Diagnosis of blepharoptosis involves a thorough clinical examination, including:

• Measurement of the palpebral fissure height
• Assessment of levator function
• Evaluation of extraocular movements
• Neurological examination to rule out underlying conditions

Additional tests may include:

• Tensilon test for myasthenia gravis
• Imaging studies, such as MRI or CT scan, if a neurological cause is suspected

Treatment

The treatment of blepharoptosis depends on the underlying cause and severity of the condition.

Surgical Treatment

Surgery is the most common treatment for ptosis and may involve:

• Levator resection or advancement
• Frontalis sling operation
• Müller muscle-conjunctival resection

Non-Surgical Treatment

In some cases, non-surgical options may be considered, such as:

• Ptosis crutches: Special glasses with a bar to hold the eyelid up
• Treatment of underlying conditions, such as myasthenia gravis

Prognosis

The prognosis for blepharoptosis varies depending on the cause and treatment. Surgical correction often yields good results, improving both function and appearance. However, recurrence or complications can occur, necessitating further intervention.

See Also

• Eyelid surgery
• Oculoplastic surgery
• Strabismus

External Links

• American Academy of Ophthalmology: What is Ptosis?
• National Center for Biotechnology Information: Ptosis Overview