Ptosis
Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
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Physicians refer to the phenomenon when one or both of the upper eyelids droop as ptosis (ptosis). Ptosis can be congenital or acquired. It occurs when individual eyelid muscles or the associated nerves are damaged. For example, an eyelid can begin to droop as a result of a stroke or abnormal muscle weakness (myasthenia gravis). Read everything you need to know about the causes, diagnosis and treatment options of ptosis here.
Brief overview
- What is ptosis? A drooping eyelid. It can be congenital or acquired.
- How can ptosis be treated? In the case of congenital ptosis due to surgery, in the case of acquired ptosis, the doctor can first wait to see whether it regresses; if not, he can also operate.
- Causes of ptosis: e.g. muscle or nerve weakness, age, stroke or damage to the sympathetic system
Ptosis: definition and meaning
Medical professionals speak of ptosis (the Greek term for "fall") when the upper eyelid of one or both eyes droop. It covers the pupil at least partially, which obstructs the view, sometimes completely. Many sufferers then consciously or unconsciously try to improve their vision from the narrowed fissure of the eyelid, for example by compulsively holding the head with the chin raised.
In some cases, the malalignment of the eyelid is congenital (congenital ptosis), sometimes the person concerned only acquires it in the course of his life. Acquired ptosis can be due to nerve paralysis (e.g. as a result of a stroke) or an injury.
The symptom can appear at any age, but overall it is rather rare. A drooping eyelid or drooping eyelids are usually congenital in childhood. At this age in particular, ptosis can lead to impaired vision (amblyopia).
Two other phenomena with similar symptoms are not to be confused with ptosis:
- Ectropion: Here the edge of the eyelid turns outwards. The lower eyelid is almost always affected. In some cases ectropion is congenital, in others it is acquired by scarring or paralysis. Most often, however, it is a change in age (senile ectropion).
- Pseudoptosis: As the name suggests, the drooping lid in pseudoptosis is not a “real symptom”. The eyelid does not hang down due to a muscle or nerve disorder, but is mostly due to an inflammatory change in the eyelid, a reduction in size or shrinkage of the eyeball.
Ptosis Treatment: What Does the Doctor Do?
diagnosis
The doctor will first collect your medical history (anamnesis) in conversation with you. He asks, for example, how long you have had drooping eyelids or eyelids and whether the drooping may increase during the day. The latter would be an indication of myasthenia gravis - an autoimmune disease in which communication between nerves and muscles is interrupted. You should also inform your doctor about any other complaints or abnormalities.
This is followed by an examination of the eyes. It often provides clues as to why the upper eyelid is drooping. For example, a one-sided symptom usually indicates damage or paralysis of nerves, while a drooping eyelid on both sides is usually muscular. If the affected eye has also sunk deeper (enophthalmos) and has a smaller pupil (miosis), it is referred to as Horner's syndrome. It is due to damage to the nerves that connect the eye to the brain.
Various tests provide other important information. In the so-called Simpson test, for example, the patient has to look extremely upwards for at least one minute. If the upper eyelid of one or both eyes slowly sinks, this indicates a high probability of pathological severe muscle weakness (myasthenia gravis).
The doctor also checks the extent of the eyelid malposition (e.g. by measuring the vertical eyelid gap) and whether there are other movement disorders in the eyes.
If it is suspected that the cause of the ptosis could be a tumor, the doctor will use imaging methods (magnetic resonance imaging, computed tomography) to clarify the situation.
Medical treatment
In the case of congenital ptosis, i.e. one that is already present in childhood, there is a risk of the eye becoming weak. That is why the affected lid is operated on - when it hangs down over half of the pupil.
If you have acquired ptosis, your doctor may wait and see. Often the symptom resolves spontaneously. If there is no improvement after six months, an operation is usually due here too. So that the hanging lid does not bother the affected person too much in the time until the operation, he can be given so-called ptosis glasses. It has a thin web that lifts the eyelid.
Ptosis: When Should You See a Doctor?
If one eyelid droops or both eyelids droop suddenly or gradually, you should consult a doctor.
Ptosis: causes and possible diseases
With regard to the cause, doctors first differentiate between congenital and acquired ptosis:
Congenital (congenital) ptosis
If the symptom is congenital, it is usually because the core area of a particular cranial nerve (oculomotor nerve) is not developed. Then it cannot fulfill its task, namely the transmission of nerve impulses to the eyelid elevator muscle - the eyelid hangs. Usually both eyes are affected.
More rarely, congenital ptosis is due to a congenital underdevelopment of the eyelid elevator muscle (with an intact cranial nerve).
Acquired ptosis
Acquired ptosis can be divided into four groups depending on the cause:
- The ptosis paralytica is based on nerve paralysis, as it can occur as a result of a stroke, inflammation of the brain (encephalitis) or meningitis (meningitis).
- Sympathetic ptosis is based on damage to the sympathetic nervous system (part of the autonomic nervous system that is responsible for increasing activity). The drooping of the upper eyelid is only slightly pronounced here. The affected eye also has a smaller pupil (miosis) and is sunk deeper (enophthalmos). All three symptoms combined result in Horner's syndrome.
- Myogenic ptosis is caused by a muscle disorder such as myasthenia gravis (a form of muscle weakness) or myotonic dystrophy (a form of muscle wasting).
- Traumatic ptosis is the result of an injury.
It is also possible that the muscles of the eyelid lifters get weaker with age. There are also suspicions that contact lenses or the lifting of the upper eyelid when inserting the lenses can promote ptosis.
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