What is ptosis?
Ptosis, which is more commonly known as droopy eyelids, refers to a condition where the upper eyelids fall to a lower position than normal. Primarily, the muscle that opens the eyelid is the levator palpebrae superioris. This action is also supported by the superior tarsal muscle. Any issues with either of these muscles may sometimes lead to ptosis.
Ptosis may affect only one eye (unilateral ptosis) or both eyes (bilateral ptosis). In severe cases, the drooping eyelid may partially or completely obstruct the pupil, resulting in a reduced field of vision.
What causes ptosis?
Ptosis can be congenital or acquired, meaning that it develops gradually over time. Some common causes of ptosis include:
- Maldevelopment of the eyelid muscles
- Injury to or stretching of the eyelid muscles or ligaments
- Damage to the nerves that control the eyelid muscles
- Neuromuscular disorders, such as myasthenia gravis
- A complication of Botox injections or eye surgery
Most commonly, ptosis develops due to the stretching of the eyelid muscles or ligaments. This could be caused by excessive rubbing of the eyes, eye surgery, or the use of rigid contact lenses. It can also be caused by eyelid tumours, cysts, or swelling. Additionally, the eyelid muscles will naturally get weaker due to ageing, making ptosis more likely to occur in old age.
What are the symptoms of ptosis?
The primary symptom of ptosis is the drooping of one or both eyelids. Other symptoms may include:
- Dry eyes
- Watery eyes
- Aching around the eyes
- Lazy eye
The symptoms accompanying each individual case of ptosis will largely depend on the underlying cause, as well as the severity of the ptosis.
Can ptosis go away on its own?
Ptosis can sometimes resolve on its own. However, this greatly depends on the cause of the ptosis. For example, ptosis caused by nerve problems may improve without any treatment. More often, ptosis is progressive in nature, meaning that it could worsen over time. In such cases, medical intervention will be needed to treat this condition. This could be surgical or non-surgical in nature.
Are there any home remedies for ptosis?
There are certain exercises and home remedies that have been said to treat symptoms of ptosis. For example, chamomile tea bag compresses are often used to reduce inflammation and calm nerves, and some believe that the consumption of Vitamin B12 can also help to treat ptosis. Some exercises believed to help with drooping eyelids include Trataka yogic eye exercises and eye patch exercises in cases of unilateral ptosis.
However, the aforementioned methods are not scientifically proven and are unlikely to give effective and lasting results. A qualified ophthalmologist will be more able to properly diagnose and treat ptosis, either through surgical or non-surgical means.
How is ptosis diagnosed?
An illustration on Marginal Reflex Distance (MRD)
While ptosis can have some obvious visible symptoms, an ophthalmologist will still need to evaluate the underlying cause of the condition to formulate an effective treatment plan. First, you will be asked specifically about your ptosis and then about your general medical history. You will most likely have to undergo a full eye exam. Your ophthalmologist may then carry out one or more of the following tests:
- Marginal Reflex Distance
This test measures the distance between the centre of the pupil and the edge of the upper eyelid. It helps your ophthalmologist gauge the extent of your condition.
- Levator Function
This test determines whether the levator muscles are functioning normally and helps your ophthalmologist decide on the best course of treatment for you.
If your ophthalmologist suspects that your ptosis is caused by an underlying condition, he or she may suggest certain blood tests, diagnostic imaging tests, or even a Tensilon test. This is when you are injected with Tensilon, or edrophonium, and asked to carry out specific actions. This test is used to measure muscle strength.
How can ptosis be treated?
Ptosis treatment depends largely on the cause and extent of the condition and can be either minimally invasive or surgical in nature. When an underlying condition is the cause of ptosis, you will most likely be treated for that condition first.
Some minimally invasive treatment options for ptosis include:
- Ptosis Crutches
These are small devices that are attached to spectacle frames to physically help lift the eyelids.
- Botox Injections
To help with ptosis, Botox can be injected into the eyebrow area to lift the eyebrow and thus, the eyelid as well. However, the effect of Botox injections is often temporary and will require regular maintenance.
- Medicinal Eye Drops
In some cases of ptosis, oxymetazoline eye drops can alleviate the symptoms of this condition. They target the levator muscles and can help lift the eyelids.
If surgery is required for your ptosis, a blepharoplasty will most likely be performed. This surgery is often used to tighten the levator muscles, although it can also be done to remove any excess mass in the eyelid. While the main goal of blepharoplasty is to lift the eyelids, your surgeon will also try to achieve symmetry for cosmetic purposes. However, this may not always be possible, especially in cases of congenital ptosis.
Other possible surgical interventions include the frontalis sling procedure, where a sling is created between the eyelid and the frontalis muscle located in the forehead. The frontalis muscle can then be used to control the upper eyelid.
What can you expect during droopy eyelid correction surgery?
After your ophthalmologist has diagnosed your condition and determined the best course of action for your ptosis treatment, he or she will explain the chosen surgical procedure to you during consultation.
The surgery itself, whether it be a blepharoplasty or otherwise, is done under local anaesthesia and it is unlikely that you will have to stay in the hospital overnight.
After the surgery, you may experience some swelling or bruising around the affected area. This can last for a period of up to 2 weeks. The full recovery period for ptosis surgery is estimated to take up to 3 months.
While rare, there are some risks associated with ptosis correction surgery. These include bleeding, infection, under- or over-correction, as well as reduced vision. If you experience any of these side effects, please return to your ophthalmologist or plastic surgeon as soon as possible.
Is ptosis surgery Medisave / insurance claimable in Singapore?
Ptosis surgery is often only Medisave or insurance claimable in cases where the ptosis results in a functional problem, meaning that it affects your vision significantly according to MOH conditions. You will require an official assessment from an ophthalmologist and must first undergo a Marginal Reflex Distance test.
Can ptosis be prevented?
In most cases, ptosis cannot be prevented. This is especially so in cases of an underlying condition that causes ptosis.
If the ptosis is not caused by any underlying conditions, avoiding excessive eye rubbing and reducing any prolonged use of contact lenses may help to reduce your risk of developing ptosis.
Ptosis is a fairly condition that is usually congenital or caused by ageing. It can affect your appearance and even your day-to-day life if your vision is affected or if you experience symptoms like headaches or migraines. If you are suffering from ptosis and would like to seek treatment or find out more about the condition, please do not hesitate to contact us.