Ptosis refers to the position of the upper eyelid margin being lower than normal, partially or completely blocking the pupil, which not only affects the appearance but may also impair vision. This symptom may involve one or both eyes and occur at any age. Its causes are complex and may be congenital or acquired, involving multiple factors such as neural, muscular, mechanical or traumatic.
1. Congenital ptosis
Congenital ptosis is due to developmental malfunction that leads to levator palpebrae superioris muscle dysfunction, accounting for about 70% of all ptosis cases. Its main characteristics include inability to open the eyes and failure of the upper eyelid to fully lift up with eye movement, sometimes accompanied by compensatory activity of the frontalis muscle, causing the child to raise his eyebrows and frown his forehead to increase the ability to open the eyes.
Common causes of congenital ptosis include:
①. Hypoplasia of the levator palpebrae superioris muscle: reduced number of muscle fibers, disordered arrangement, or abnormal connection between the tendon and the tarsal plate.
② Abnormal development of the oculomotor nerve: resulting in insufficient innervation of the levator palpebrae superioris muscle.
③. Syndromic diseases: such as Blepharophimosis syndrome, manifested by bilateral ptosis, narrowing of palpebral fissures, etc.
If not treated promptly, it may cause amblyopia or visual development disorders , and early intervention is required.
2. Acquired ptosis
There are many types of acquired ptosis, which can be divided into the following categories according to the cause:
1. Neurogenic ptosis
This type of ptosis is mainly due to damage to the nerves that supply the levator palpebrae superioris muscles. Common causes include:
Oculomotor nerve palsy : The oculomotor nerve controls the levator palpebrae superioris muscle. Its damage is often accompanied by eye movement disorders and pupil changes. It is more common in cerebrovascular disease, diabetes, intracranial tumors, and craniocerebral trauma.
Horner syndrome : caused by damage to the sympathetic nerve chain, in addition to mild ptosis, it is also accompanied by symptoms such as pupil constriction and enophthalmos, and is often related to neck tumors or trauma.
Myasthenia gravis : An autoimmune disease with impaired conduction at the neuromuscular junction, characterized by fluctuating ptosis and diplopia, which worsens with exertion and improves with rest.
2. Myogenic ptosis
One of the common causes is the weakening of the function of the levator palpebrae superioris muscle due to its own lesions.
Muscular dystrophy : such as oculopharyngeal muscular dystrophy, which causes slowly progressive bilateral ptosis.
Extraocular muscle inflammation or muscle fiber degeneration : affects muscle contraction force.
3. Mechanical ptosis
The upper eyelid tissue increases in weight due to mechanical factors such as lumps, scars, and swelling, causing drooping:
Eyelid tumor or cyst : compression or traction of the tarsal plate.
Chronic inflammation or traumatic scarring of the conjunctiva : affects the structure and movement of the tarsal plate.
Eyelid swelling : Thyroid-related eye disease can cause heavy eyelids.
4. Traumatic ptosis
Eyelid trauma, surgical injury or iatrogenic operation can lead to damage to the levator palpebrae superioris muscle or oculomotor nerve, often manifesting as sudden unilateral ptosis. Recovery varies depending on the extent of the damage.
5. Senile (degenerative) ptosis
Degeneration is a common cause of ptosis in the middle-aged and elderly population, mainly due to the relaxation of the levator palpebrae superioris aponeurosis or loosening of its attachment to the tarsal plate. Factors such as long-term wearing of contact lenses, repeated rubbing of the eyes, and postoperative scar traction can accelerate this process.
Symptoms include difficulty opening the eyes and limited visual field, and the symptoms often worsen in the evening.
3. Diagnosis and Assessment
A comprehensive assessment of ptosis requires a combination of medical history, physical signs, and auxiliary examinations:
Visual acuity and visual field assessment : determine whether visual function is affected.
Measurement of palpebral fissure height : record the width of eye opening, the relationship between the upper eyelid edge and the pupil.
Levator palpebrae superioris muscle strength measurement : used to determine muscle function.
Neurological examination : Identify whether there are abnormalities in oculomotor and sympathetic nerve function.
Ice test and acetylcholine test : used to screen for myasthenia gravis.
Imaging examinations : such as MRI or CT, to determine whether there are intracranial lesions, tumors, or neural pathway damage.
IV. Treatment Principles
Treatment of ptosis requires an individualized treatment plan tailored to the cause.
Autoimmune diseases such as myasthenia gravis : shouxuan drug treatment (such as anticholinesterase drugs, immunosuppressants).
Neurogenic diseases such as oculomotor nerve palsy and Horner syndrome : Treat the primary lesion. Some patients recover slowly and need to consider surgical intervention at a later stage.
Myogenic and senile ptosis : often require surgical repair of the levator palpebrae superioris muscle or frontalis muscle suspension.
Mechanical and traumatic lesions : focus on removing the pathogenic factors and restoring the anatomical structure.
Congenital cases : If there is a risk of amblyopia, early surgical intervention should be performed.
Surgical treatment should follow the principle of "function first, aesthetics taken into consideration" to avoid complications such as excessive eye opening and incomplete eye closure after surgery.
5. Prognosis and care of ptosis
The prognosis for ptosis varies depending on the cause:
Early diagnosis and intervention can effectively avoid visual development disorders.
Some neurogenic ptosis can recover naturally, while some may require surgical assistance.
Postoperative care includes avoiding rubbing the eyes vigorously, taking anti-inflammatory drugs on time, monitoring eye closure, and preventing exposure keratopathy.
④. For patients with concomitant systemic diseases, such as hyperthyroidism and diabetes, the underlying diseases should be actively controlled to prevent recurrence of the disease.
Beauty Encyclopedia Tips:
Ptosis not only affects appearance, but may also hide major diseases of the nervous or muscular systems. If you experience symptoms such as difficulty opening your eyes and heavy eyelids in daily life, you should seek medical attention in time for a clear diagnosis. For individuals with a family history or recurrent attacks, regular eye examinations are recommended to identify risks early and intervene reasonably. Although surgery is one of the main treatments, it should be selected with caution based on clarifying the cause and assessing the risks. Scientific care and professional treatment can ensure the harmonious unity of eye health and visual function.