Ptosis is defined as the situation in which the upper eyelid descends with respect to the normal position or with respect to that of the other eye. In the forward gaze, the upper eyelid covers the cornea 2 mm under normal conditions.
This situation can produce partial or total occlusion of the pupillary area, with the visual deficit that this entails.
The causes are multiple and diverse, from which it follows that there are multiple classifications. Any pathology that affects the neuromuscular complex of the eyelid suspensor apparatus, such as:
- Neurogenic causes: Oculomotor nerve palsy, Horner syndrome, synkinesis, ophthalmoplegic migraine…
- Myogenic causes: Congenital (simple congenital ptosis, or associated with other morphological and functional palpebral alterations) and acquired (myasthenia gravis, myotonic dystrophy, ocular myopathy, oropharyngeal muscular dystrophy …)
- Alterations of the aponeurosis: Involutive linked to age, postoperative, post-traumatic, post-inflammatory, pregnancy …
- Mechanical: By weight on the eyelid (dermatochalasis, blepharochalasis, tumors), restrictive (symblepharon).
The diagnosis is made by valuing data from the clinical history as the time of onset, mode of presentation, accompanying signs and symptoms, in order to identify the cause and thereby approach the treatment.
Subsequently, the data that should always be quantified is the function of the muscle responsible for the voluntary lifting of the eyelid (levator palpebrae superioris muscle). Depending if the function is good, deficient or bad, a surgical or another approach will be considered.
It depends fundamentally on the cause that originates the palpebral malposition, as well as the type of surgery required. The most limiting fact of surgery is the danger of generating a lagophthalmos (inability to close the eyelids completely) due to hypercorrection; thus, many times the majority of cases recover without sequelae, when the cause is congenital (present from birth) several surgeries may be necessary throughout the period of the patient’s growth.
When the loss of function of the levator muscle is mild-moderate, a partial resection (shortening) of the muscle is practiced. But if the loss of function is serious, so that the muscle has a little function, the surgery consists of creating eyelid suspension elements, ineffective muscle substitutes (with muscle flaps, grafts of autologous material such as fascia lata or heterologous as bovine pericardium).
Each eyelid receives a personalized treatment according to the cause and the degree of affectation.
It is recommended that in the presence of ptosis, immediately attend a specialised center such as Harley Street Hospital, for the early detection and appropriate treatment of the pathology.