PtosisPtosis is the term used for drooping of theupper eyelids. It is of two types, namelycongenital ptosis and acquired ptosis. Con-genital ptosis is more common than acquiredptosis. Ptosis may involve one or both theeyes and ranges from mild to severe. In caseof mild ptosis, the eye has an undesirableappearance but is functionally normal.Whereas, in severe ptosis the drooping upperlid covers the pupil and visual axis of the eye;so the patient has to lift his/her chin to seeproperly.

Congenital PtosisPresent at birth, the reason for congenitalptosis is the poor development of the eyelidlifting muscle called the levator muscle. Achild may have only ptosis or may haveother associated eye abnormalities like eyemovement disorders, refractive disorders andneurological disorders as well.

Acquired PtosisAcquired ptosis may occur at any time afterbirth, but more commonly in old age. Theusual cause for this is, weakening of the

eyelid lifting muscle, the levator. Weakeningof the levator muscle and the resultant droopof upper eyelid may occur due to factors likeold age, injury, surgery, muscular disease andneurological disease.

Symptoms• Drooping of the upper eyelid in both the

eyes which may be mild or severe so as tocover the cornea.

• Tired appearance of the eyes.• Undesirable facial appearance due to

drooping of the upper eyelid.• Elevated chin in cases of severe ptosis.• Poor vision due to associated refractive

errors.• Stiff neck due to constant chin elevation.• Decreased vision when the droop is severe

and covers the pupil.

TreatmentPtosis gives an undesirable facial appear-ance. Normal vision is affected in severeptosis which finally hinders the normalactivities of the person. Even in cases of mildptosis, treatment is necessary in order to givethe person full opportunity to lead a normallife. A child having ptosis has a psychologicalhandicap in relation to other normal chil-dren. Hence, ptosis should be treated as earlyas possible, otherwise it may lead to abnor-mal head positions and / or decreasedvision. Treatment provides a desirable facialappearance as well as normal vision.

SurgeryThe treatment is surgery. It usually involvesone of the following procedures. Strengthen-ing the eyelid lifting muscle, the levator, or a

Preoperative

Postoperative

PtosisUpper Eyelid

Drooping

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PIB/Orbit/Ptosis/Ptosis-Eng.pmd (04.2003)

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mechanical lifting-up of the eyelid with thehelp of a thread like material called sling.Levator surgery is done in cases of mild ormoderate ptosis and sling surgery is done incases of severe ptosis. The levator muscle isstrengthened by surgery so as to allow it tolift the eyelid normally. The surgery for ptosisis quite safe and effective.

Postoperative periodThe aim of the surgery is to have equal lidheight in both the eyes. However,undercorrection or overcorrection may occuroccasionally and this can be rectified. Duringthe initial postoperative period the personmay not be able to close the eye completely,but this gets rectified in few weeks. In addi-tion, when the patient looks down, the whiteof the eye (sclera) becomes visible above thecornea (the central round dark part of theeye). The patient has to learn to move hishead rather than his eye downward to avoidthis.