You may fi nd it more and more diffi cult
to keep your eyes open, or you may feel
eye strain and eyebrow ache from the
increased eff ort to raise the lids, or fatigue
when reading. In severe cases, it may be
necessary to tilt your head backward in
order to see from under the eyelid. Your
family and friends might also notice that
you have a constantly ‘tired’ appearance.
Ptosis may be present at birth (congenital)
or appear later in life (aquired).
Congenital ptosis is usually a result of
maldevelopment of the levator muscle
responsible for the lifting of the upper lid.
Acquired ptosis has several causes.
Among them, the most common cause
is the stretching of the levator muscle,
due to the ageing process. This is called
It is also not uncommon to develop
this type of ptosis after eye surgery or
after contact lens wear. Other causes of
ptosis include third cranial nerve palsy
and neurological muscular disorders
such as myasthenia and muscle
The type of treatment available
depends on the cause of the ptosis.
Aponeurotic ptosis can frequently be
Surgery is usually performed under local
anaesthesia. The main goal of surgery
is to elevate the upper eyelid to permit
better vision. At the same time, the
surgeon aims to achieve a reasonable
amount of symmetry. Good to excellent
results can be achieved although perfect
symmetry may not always be obtained.
Congenital ptosis is different from
acquired ptosis in that the surgeon has
to deal with an abnormal muscle. When
operating on an abnormal muscle, it is
not always possible to achieve complete
symmetry of both lid positions and
function after surgery. Patients with
congenital ptosis may still have a
drooping lid on up-gaze and the white
of the eye (sclera) will become visible on
down-gaze. There may be inadequate
lid closure during sleep.
Congenital ptosis is usually repaired in
childhood if it is severe and obstructs
vision. If mild, it can be repaired either in
later childhood or early adulthood.
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