Ptosis is a drooping of the upper eyelid. The lid may droop only slightly, or it may cover the pupil entirely. In some cases, ptosis can restrict and even block normal vision. It can be present in children, as well as adults, and may be treated with surgery.

Ptosis can affect one or both eyelids, be inherited, be present at birth or occur later in life.

Ptosis that is present at birth is called congenital ptosis. If a child is born with moderate to severe ptosis, treatment may be necessary to allow for normal vision development.

Ptosis in children
Congenital ptosis is often caused by poor development of the muscle that lifts the eyelid, called the levator. Although it is usually an isolated problem, a child born with ptosis may also have: eye movement abnormalities, muscular diseases, lid tumors or other tumors, neurological disorders or refractive errors.

The most serious problem associated with childhood ptosis is amblyopia. This can occur if the lid is drooping severely enough to block the child's vision. More frequently, it can occur because ptosis tends to change the optics of the eye, causing astigmatism and constant blurring of the visual image. Finally, ptosis can hide misaligned or crossed eyes, which can also cause amblyopia.

If amblyopia is not treated early in childhood, it persists throughout life and may lead to permanent vision loss.

Congenital ptosis treatment
In most cases, treatment for childhood ptosis is surgery. If amblyopia is present, treatment with patching, glasses and/or eyedrops may also be necessary.

During surgery, the levators are tightened. In severe ptosis, when the levator is extremely weak, the lid can be attached or suspended from under the eyebrow so that the forehead muscles can do the lifting.

Mild or moderate ptosis usually does not require surgery early in life. Children with ptosis, whether they have had surgery or not, should be examined regularly by an ophthalmologist. Even after surgery, focusing problems can develop as the eyes grow and change shape.

Ptosis in adults
The most common cause of ptosis in adults is the separation of the levator muscle tendon from the eyelid. The process may occur as a result of aging, after cataract surgery or other eye surgery, as a result of an injury, from restriction of the levator, as may happen in the case of an eye tumor.

Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as diabetes.

Adult ptosis treatment:
The ophthalmologist may use blood tests, X-rays or other tests to determine the cause of the ptosis and plan the best treatment. If treatment is necessary, it is usually surgical. Sometimes a small tuck in the lifting muscle and eyelid can raise the lid sufficiently. More severe ptosis require reattachment and strengthening of the levator muscle.

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