Ptosis Palpebral

• February 12, 2023
• By Fernando Amato

What is Palpebral Ptosis? What are the types? What is the treatment? How is the surgery? Does insurance cover it? Are there risks?

What is palpebral ptosis?

It is a condition in which the upper eyelid droops over the eye, affecting the complete opening of the eye and impairing the visual field. It can occur in only one eye (unilateral) or in both eyes (bilateral) and can be congenital or acquired due to muscle diseases, nerve conditions, trauma, or other causes. The treatment varies depending on the muscle function and the degree of the condition. It is important to seek medical help to evaluate the best therapeutic approach.

What are the causes?

Palpebral ptosis can have several causes, including:

1. Congenital: Congenital ptosis occurs when the muscle that lifts the upper eyelid does not develop properly or does not function correctly from birth.

2. Aging: Palpebral ptosis can occur naturally with aging, due to the loss of elasticity of the skin and eyelid muscles.

3. Trauma: Injuries to the eye area or eyelids can cause palpebral ptosis.

4. Neuromuscular diseases: Neurological or muscular conditions, such as myasthenia gravis, muscular dystrophy, and Parkinson's disease, can cause this condition.

5. Previous surgeries: Previous ophthalmological or eyelid surgeries can damage the upper eyelid muscles and cause ptosis.

6. Medication use: Certain medications, such as muscle relaxants and antidepressants, can cause this as a side effect.

7. Thyroid problems: Hypothyroidism, a condition in which the thyroid does not produce enough hormones, can cause palpebral ptosis.

What are the symptoms of palpebral ptosis?

The main symptoms are:

• The drooping of the upper eyelid covering part of the affected eye;
• Feeling of tiredness or effort to keep the eyelid open;
• Difficulty in completely opening the affected eye;
• Blurred or double vision, due to partial obstruction of vision by excess eyelid skin;
• Headache, especially when the ptosis is bilateral and chronic;
• Elevated eyebrow and wrinkles on the forehead, due to the compensatory attempt to lift the eyelid.

It is important to note that symptoms may vary according to the cause of palpebral ptosis and the degree of impairment.

What is the difference between congenital and acquired?

Congenital palpebral ptosis is a condition present from birth, usually caused by muscle or nerve problems in the upper eyelid.

Acquired palpebral ptosis, on the other hand, is a condition that appears later in life, usually due to muscle or nerve problems related to aging, injuries, neurological diseases, or medication side effects.

Congenital palpebral ptosis can be more severe and require surgical treatment earlier, while acquired ptosis can often be treated with conservative measures, such as wearing glasses or using eye drops to help open the eye.

Surgery can also be an option for acquired palpebral ptosis, but this is usually only performed when the condition significantly affects vision or causes other problems.

What treatments are available for this condition?

Treatments may vary according to the cause of the condition and the degree of impairment. Some of the available treatments include:

1. Observation: In some cases, it may be mild and not significantly affect vision or aesthetics. In these cases, the doctor may only monitor the condition without prescribing any treatment.

2. Wearing glasses: In some cases of mild palpebral ptosis, wearing glasses can help lift the affected eyelid and improve vision.

3. Medical treatment: In cases of palpebral ptosis caused by underlying health problems, such as myasthenia gravis or other neuromuscular diseases, medical treatment of these conditions can help improve palpebral ptosis.

4. Surgery: In cases of moderate to severe palpebral ptosis, surgery is usually the most effective treatment. Different surgical techniques are available, depending on the cause and degree of impairment. Surgery may involve repairing the levator muscle of the eyelid, removing excess skin, or lifting the eyelid using a tissue graft or a suspension suture.

So, it is important to remember that an ophthalmologist or plastic surgeon specialized in eyelid surgery should prescribe the appropriate treatment.

What are the surgeries for correcting palpebral ptosis?

Several different surgical procedures can be used to correct palpebral ptosis, including:

1. Upper eyelid lift: This surgery involves augmenting the muscles or tendons of the upper eyelid to lift the eyelid and improve vision.

2. In frontalis muscle suspension, surgeons perform suspension of the muscle in the forehead called the frontalis muscle to help lift the upper eyelid.

3. Müller's muscle elevation: This surgery involves elevating Müller's muscle, a muscle in the upper eyelid, to improve the eyelid's position.

4. Blepharoplasty: This surgery involves removing fat and tissue from the upper eyelid to improve the appearance and position of the eyelid.

5. Combined surgery: Sometimes, a combination of several of these surgeries may be necessary to treat palpebral ptosis.

In summary, the choice of surgery to be performed depends on the degree of ptosis and the underlying cause, and it is important to remember that a prior medical evaluation is necessary to identify the best option for each specific case.

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