What is ptosis? What causes it?

You suffer from ptosis of the eyelid; you wonder how to treat it to regain your bright and healthy eyes. Prima Health Saigon Medical Center will help you answer the above questions and concerns immediately. Drooping eyelids has many causes and treatment modalities, but it is necessary to identify each case clearly to provide the most appropriate treatment.

What is the cause of drooping eyelids?

What is ptosis?

Ptosis (also known as drooping eyelids) is a prolapse of the upper eyelid to a lower-than-normal position due to the loss of elasticity or droopy eyelid skin forming fat pockets in the upper eyelid or due to wrinkled skin in the corners of the eyes and damage to nerve No. 3 and Horner syndrome or causes Local nuclei to include congenital or acquired lesions of the eyelash lift muscles, tumours, and bacterial infections or due to myasthenia gravis.

Does ptosis go away on its own?

Drooping eyelids are a natural ageing of the muscles of the eyelid area that leads to a decrease in elasticity, making the eyelids lower, making the eyes look tired and ageing. So many people wonder if ptosis will go away on its own.

Because this is a natural and inevitable ageing condition, as age increases, there is no way to prevent it entirely. However, proper health and beauty measures can help minimize drooping eyelids and keep eyes youthful.

Whether surgery is a need for treating ptosis?

In severe cases, surgery will be the best treatment. However, treatment is unnecessary if the symptom is mild and does not cause vision problems.

Causes of ptosis

In the normal eye, the distance from the centre of the cornea (irises) to the lower shore of the upper eyelid when the patient looks straight is 4-4.5mm (or the lower coast of the upper eyelid covers the upper pole of the cornea by 1-2mm). Drooping eyelashes are when there is an abnormal prolapse of the upper eyelid. Accordingly, the ptosis of the eyelids is divided into two groups.

How many kinds of ptosis?

• Congenital ptosis: This is the most common occurrence and occurs from birth. Caused by partial or complete underdevelopment of the eyelash lift muscle during embryogenesis. This disease can occur in one eye or both eyes. There are cases of drooping eyelids alone, but there are also cases accompanied by other abnormalities such as dyskinesia of the eyeball, drooping eyelids combined with narrowing of the eyelids…
• Acquired ptosis: Acquired drooping eyelids occur at any time or age. Here are some of the causes.

What are the causes of drooping eyelids?

Causes of ptosis

• Age: Drooping eyelids are a common symptom of the ageing process and often occur in older people. The muscles inside the eyelids become weaker over time, leading to drooping.
• Muscle depletion: Ptosis can be caused by muscle deterioration in the eyelid area. Muscles become weak due to excessive stress or health problems like Parkinson’s disease.
• Trauma can also be caused by trauma or surgery near the eyelid area.
• Conditions: Some conditions, such as Graves’ disease, Alzheimer’s disease and nervous system disease, can lead to this disease.
• Genetic factors: There are some cases of drooping eyelids inherited from parents.

Accurately identifying the cause of ptosis is crucial to devising effective treatment.

Degrees of ptosis

Currently, based on the distance between the upper and lower lashes, people divide each level of drooping eyelashes, and it is divided into 4 degrees:

• Grade I (mild): the eyelashes above the pupil bank mainly affect aesthetics, not yet affecting vision.
• Grade II (moderate): the lashes drooped a lot, covering part of the pupil, which affected vision.
• Grade III (severe): the eyelash exceeds the centre of the pupil.
• Grade IV (very severe): the eyelashes cover the pupil.

Symptoms of ptosis

Signs of ptosis in children and adults

Ptosis of the eyelids is a common problem in many people and can cause a lot of discomfort and affect aesthetics. Its symptoms may include:

• Eye spots are lower than usual or bulging.
• The eyelid line is shifted or changes shape.
• Difficulty in seeing because the collapsed area obscures the view.
• Problem wearing glasses or eyelid area makeup.

In severe cases, the patient will have blurred vision; if not detected and treated in time, children may have amblyopia due to covering, eyes may be strabismus, strabismus. It can also manifest as serious diseases such as myasthenia gravis and cranial nerve palsy III (due to brain tumour…). If not detected, timely treatment can affect the patient’s life.

In addition, ptosis can cause other symptoms such as eye strain, headaches, discomfort when seeing, and even tearing due to affecting the airflow of the tear orifice. However, its symptoms can vary depending on the problem’s extent and cause.

Treatment of ptosis

Should we cure ptosis with or without surgery?

How to cure ptosis without surgery

This condition is a fairly common problem for many people, especially adults and older people. Therefore, they may think it requires surgery and must be done immediately. However, in some cases, non-surgical treatments may improve effectively.

Here are some non-surgical treatments:

• Contact lenses: Contact lenses can be used to reduce drooping eyelids. Contact lenses help create light pressure on the eyelids, which elevates the hanging eyelid area.
• Massage: A gentle eyelid massage can also help improve it. Massage enhances blood circulation and reduces swelling.
• Use eyelid fillers: Eyelid fillers can help improve ptosis by filling the gap between drooping eyelids.
• If your problem is caused by stress, lack of sleep, or improper eating, lifestyle changes can help improve entirely.

However, non-surgical may only be effective in mild cases. Surgery may be the only method to resolve ptosis in more severe cases. Therefore, you should seek an eye specialist for advice and proper treatment before using any treatment.

Cure drooping eyelids requires surgical intervention

Cure ptosis of the eyelids by surgical methods

In some severe cases, surgical intervention is necessary to reconstruct the eyelid position and improve the appearance of the face. In children, the age set for surgery is currently unknown. But usually, congenital ptosis is operated on between the ages of 4 and 5 years. However, if your baby has severe eyelid collapse, amblyopia or head misalignment, an earlier surgery is needed, possibly as early as 1 year.

Some notes to know when undergoing drooping eyelids surgery:

• Surgery at the eyelids, which does not interfere with the irises at all.
• At the beginning of surgery (first 1-2 months), the eyes cannot close when sleeping, and white irises can be seen when looking down. The treatment against dry eyes during this period is essential since the eyes are not closed.
• Do not let the irises dry out; keeping the irises always slippery is necessary.
• The patient practices closing his eyes; glancing in the direction is necessary.
• Keep your eyes clean.
• Instillation, apply ointment according to the doctor’s prescription.
• Follow-up visits on time.

Conclusion

To determine the exact cause of ptosis of the eyelids or not must be examined and consulted by experienced doctors. Because some cases of “fake collapse” due to small eyes, excess eyelash skin, indented eyes due to trauma, no eyeballs or pathological eyeball atrophy…  can be confusing.

At Prima Health Saigon Medical Center, the doctor will determine the exact cause of drooping eyelids, the degree of ptosis, and the function of the eyelid lift. Patients will be consulted and treated according to the most appropriate regimen.

Our Ophthalmology Care Team:

• Dr THAO Vo, Chief Medical Officer, Prima Medical Center Saigon
• Dr AN Trinh, Head of General Ophthalmology
• Dr QUOC Nguyen, Senior Consultant