Ptosis /ˈtoʊsɪs/ (from Greek Ptosis or πτῶσις, to "fall")
Ptosis or Blepharoptosis refers to drooping of the upper eyelid and is also known by many names, it is usually known as "lazy eye", "droopy eye" and so on. It must not be mistaken with amblyopia, which is also called lazy eye, which is a disorder of the visual system in the brain.
Regardless of the cause, when ptosis obstructs vision, it is disabling. It may be classified as acquired (Usually in Older people) and congenital (if you are born with it). It can also be classified by the cause of the Ptosis.
There are two muscles that are involved in the elevation of the upper eyelid the levator palpebrae superioris and the Mueller's muscle. The levator palpebrae superioris contributes to most of the elevation of the eyelid, It contributes approximately 1 to 2 mm to the elevation of the upper eyelid while the Mueller's muscle contributes to the over-elevation of the eyelid when the individual becomes excited or fearful and leads to mild ptosis with fatigue or inattention.
Causes can be.
- Myogenic; This is when there is a problem with the muscles of the upper eyelid. This may be congenital or due to other diseases such as Myasthenia gravis.
- Aponeurotic; Which may be post-operative.
- Neurogenic; Problems, with the nerves that supply the muscles that open the eyelid
- Mechanical; This is when the dropping is caused by either swelling of the upper lid or by tumors
- Pseudoptotic.; This is due to lack of support due to a small eyeball, or lack of the eyeball.
- Botulinum toxin — It may be a complication of botulinum toxin (Botox) therapy when used in the treatment of blepharospasm (eyelid spasm) and cosmetic treatment of forehead. Up to 11 percent of patients treated for blepharospasm had ptosis as a complication.It generally resolves over three to four weeks usually.
Of note the ptosis may not be evident at all times and may become more evident during the day when the person becomes tireder, this may be benign or may be indicative of neuromuscular diseases such as Myasthenia gravis or rarely Lambert-Eaton myasthenic syndrome.
It may also be Pseudoptosis — An eyelid may appear ptotic due to its position with respect to the eyeball, and there are a number of causes for this, for example lid retraction of one eye may give the false appearance of ptosis in the opposite eye or in the In elderly patients, redundant eyelid skin may give the impression of ptosis.
In children, it is caused usually by myogenic dysgenesis (poor muscle development), but other causes such as birth trauma must also be ruled out
A few Landmarks
The palpebral fissure is the distance between the upper and lower eyelid at the axis of the pupil. The normal palpebral fissure measures 9 to 12 mm.
Another measurement reference can be done when a point source of light directed at the person's eye which will stimulate pupillary light reflex (when the pupil constricts). The distance from this reflex to the upper eyelid margin is called the margin reflex distance. The normal for this measurement is 4 to 5 mm. The margin reflex distance is often more helpful than palpebral fissure since lower lid position may vary individually.
The palpebral fissure and margin reflex distance provide an objective means of identifying ptosis and measuring its severity that may be useful in planning treatment
There are a few features that can possibly help identify the cause of the ptosis, but that goes beyond the scope of this hub.
The treatment depends on the cause. For adults who do not want to undergo surgery, there are special glasses with a crutch attached that can be used to lift the lid.
The definitive solution for ptosis is surgery. There are many techniques and methods, all depending on the cause of the ptosis and the age of the patient and ultimately the surgeons preference.
Not all people with ptosis are candidates for surgery and all people opting for this option have to be assessed by an oculoplastic surgeon (eye plastic surgeon) who will examine the whole of the upper and middle part of the face to detect asymmetry, because asymmetry or a small eyeball can give a false or pseudo-ptosis.
The surgery is a day case surgery and you may have to look like a pirate for 2-4days.
Complications are minimal but can occur. These include
- Lagophthalmos or failure of the eye to close completely which may lead to dry eye, which may damage the cornea and may lead to blindness if, not corrected.
- Scarring from the surgery
- Deformity of the eyelid
- Asymmetry of the lid position
If you need more information you should see you ophthalmologist. This is very important for children with ptosis or any other abnormal looking eyes because they may have other conditions which have to be addressed, early on before it is too late to correct such a neurological disorders, amblyopia and others.
Tegan Quin on Ptosis
Others include Thom Yorke of Radiohead, and Lenny Kravitz.
Jen on August 06, 2020:
I have it in my left eye as a result of ophthalmic shingles.
Sofia on May 29, 2020:
I visited 3 ophtalmologists because one eye is with ptosis. I was not like this and the eyes is always crying which adds other problemas as infection because I am always cleaning the eye and the under eye area has suffered a lot and has more wrinkles than the other eye.
They told me that it could be allergy , that the lacrimal of the eye may have problems but I think there is something more, They don't pay attention that the eye is smaller than the other. I am frustrated so I am planning to visit a neurologist to see if there is any neurological problem. I am 50 years and one told me that is natural that the eyelids fall down but my mother is 70 and her eyes are the same with natural wrinkles but not that one is bigger than the other.
Patty Ptosis on October 17, 2015:
Paris Hilton clearly is not faking her Ptosis, you can see kid pictures of her with obvious signs of it. But I will say that when she got out of jail it was less obvious, probably because she wasn't on a computer or a cellphone for excessive amounts of time, or she got more sleep than normal, resting her eye muscles a bit. I know if I get a good 8 hours of sleep, my ptosis is less apparent.
Bridie hitches on May 14, 2015:
I have ptosis recently I have a constant infection in the ptosis eye. I have been told that if I have the operation I could have over correction?????? Any help
Harjinder Paaji on January 12, 2015:
Great and a very useful blog for me. Thanks a lot for sharing the blog.
Majidsiko (author) from Kenya on January 11, 2015:
Intermittent Ptosis may be relayed to mysthenia gravis I suggest you get it checked out
Laurie on July 14, 2014:
I get this 2 or 3 times a year and lasts about a month and a half then goes away. It drives me nuts!! Everyone is what's wrong with ur eye? I hate going anywhere when my eye gets like this. Driving is horrid. I have no health insurance so I have to deal with it!!
Ken on November 11, 2013:
Stuart Scott has ptosis from a football injury while covering the Jets
Stef on July 25, 2013:
British soul star Gabrielle has ptosis
rozebow on October 30, 2011:
I have ptosis on one eye was born with it,and have had 3 surgeries it still is very hard to live with looks nothing like the other eye..
fakename on August 04, 2011:
What about Tegan Quin?! She talks about it all the time! She even has this hilarious video where she tries very hard to keep a straight face and talk about her ptosis.
Joshua on March 31, 2011:
There are cases where somebody's strabismus only shown up when tired.
Mine only shows up after being behind a computer screen or when i'm tired, also stress may cause it.
Lucy on March 01, 2011:
No this article isn't suggesting that shes FAKING IT. It is just not known for definate whether she has it or not because some photo's show her with a lazy eye like the one above. I very much doubt that Paris Hilton would even know what Ptosis is !
kybelian on January 28, 2011:
WTF!? You hate Paris Hilton so much you suspect her of faking ptosis? Why? So she can be different?
Katie McMurray from Ohio on April 08, 2010:
Now that you mention it...Great Hub. Thanks and Peace :)