What Treatments Are Available For Different Types Of Ptosis?

In some cases, the same diagnosed condition can necessitate a wide range of different treatments depending on its intensity, causes and the needs of a particular person who has it, and one of the most common examples of this is found with eyelid droops.

Known as ptosis, the dropping or drooping of the eyelid is not uncommon to some degree, but in most cases, the consequences are simply aesthetic, with one eyelid hanging lower than the other but not over the eye itself.

Besides appearance considerations, a significantly dropped eyelid can cause potential vision problems, particularly if it affects vision development and causes conditions such as amblyopia (lazy eye).

All forms of ptosis are related to the function of the levator muscle that controls the upper eyelid, but treating it typically involves treating the cause of the eyelid droop. A neurosurgeon will typically use different approaches depending on the type of ptosis that has been diagnosed.

Here are some common types of ptosis and the potential treatments that are available.

Congenital Ptosis

One of the most common causes of ptosis is being born with the condition, typically because the levator muscle did not completely develop before birth.

It is typically idiopathic, with a somewhat unknown cause. As it affects people from birth, it will typically be examined to avoid the risk of lazy eye but may go untreated in relatively mild cases until later in life.

Surgical correction of the eyelid is the most common treatment if any other cause is ruled out, and is often required if it is considered to be the cause of potential eye issues, as severe cases of amblyopia cannot be fixed once a child reaches a certain age.

The most common type of surgery is levator resection, which shortens the length of the muscle and thus raises the height of the eyelid.

Aponeurotic Ptosis

One of several forms of acquired ptosis, aponeurotic ptosis is typically caused by an overstretching of the levator muscle.

The most common reason for this is ageing, which can lead to one eyelid drooping lower than the other, but it can also be caused by excessive pulling of the eyelid or rubbing of the eyes.

The latter can be potentially problematic because one symptom of eyelid droop is that it causes irritation or tearing of the eyes that often leads to further rubbing.

Surgery is also common for aponeurotic ptosis, and the type of surgery used depends on the strength of the stretched-out eyelid muscle.

If it is strong enough, then levator resection can be effective, but in other cases, a treatment known as a frontalis sling is used instead.

A frontalis sling uses a material that is then threaded underneath the frontalis muscle and uses those muscles when raising the eyebrows to also raise the eyelid.

Neurogenic Ptosis

Neurogenic ptosis is caused by a nerve issue that causes the upper eyelid to remain closed, either partially or completely, typically as a symptom of another medical condition.

One example of this can be seen in Horner’s syndrome, a condition caused by damage to the sympathetic trunk that causes partial ptosis alongside a constricted pupil, decreased sweating and misplacement of the eyeball.

Treating neurogenic ptosis requires treatment of the underlying condition, which can require neurosurgery or stereotactic radiosurgery to restore the proper function of the nerve by removing anything pressing against it.

Myogenic Ptosis

A case of myogenic ptosis is typically caused by a progressive muscle disorder such as myotonic dystrophy, which can affect other facial muscles or muscles in the body.

As the condition involves progressive muscular weakness, the most common form of treatment is a frontalis sling, as that allows less affected muscles to maintain strength in the eyelids.

Mechanical Ptosis

In some cases, the cause of an eyelid droop is physical pressure on the eyelid, which is commonly the result of a tumour, lesion or oedema.

Here, the treatment involves surgery or radiosurgery to remove the cause of pressure, which will typically fix the problem by itself.

In some cases, it may be paired with additional surgical treatments in order to restore symmetry to the eyelids.

Neurotoxic Ptosis

It is unlikely that anyone will visit a specialist clinic with neurotoxic ptosis, but in some cases, temporary drooping of the eyelids is a symptom of poisoning or envenomation, typically as the result of a bite from a venomous snake.

Snake venom tends to be neurotoxic in nature, which causes muscular paralysis, including in the eyelid.

In this instance, the condition is life-threatening and emergency treatment using antivenom is essential for survival.

Learn more about our advanced neurosurgical treatments for ptosis on the Queen Square website.