What is Ptosis?
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Causes
Ptosis, commonly referred to as drooping eyelids, can occur due to several factors, including aging, muscle weakness, nerve damage, or other underlying health conditions. Understanding the causes of ptosis is crucial, as it can guide individuals in determining appropriate treatment options. There are two overall types of ptosis:
Congenital Ptosis
Congenital ptosis is the scientific name for ptosis obtained at birth. It is not confirmed what the cause of congenital ptosis is, but some scientists have theorized that ptosis can be autosomal. I for one, have an uncle that has ptosis, so I partially credit my congenital ptosis to my father's genes.
Histologically, congenital patients' muscles that levitate the eyelids are dystrophic.
Key Words
-Autosomal
Having to do with any of the 22 numbered pairs of chromosomes found in most human cells
-Histologically
Relating to the study that surrounds the structure of cells and tissue at the microscopic level
-Dystrophic
A disorder in which an organ or tissue of the body deteriorates
-Laterally
Sideways
Acquired Ptosis
Acquired ptosis is the type of ptosis developed overtime, not ptosis that you are born with (congenital ptosis). In this case, the muscles used to lift the eyelid becomes overstretched, often due to aging. In some cases, excessive eye rubbing or eyelid pulling can contribute to obtaining acquired ptosis. Eye rubbing and eyelid pulling can be caused by eye irritation or long term contact lens. Long term contact lens can add to the possibility of developing ptosis because certain people during the removal and insertion procedure of the contact lens apply abnormal force to the eyelid while manipulating their lens. This is especially true during removal, since pulling the eyelid laterally to remove the lens can overtime stretch the eyelid.
Certain diseases or other health conditions can also help cause acquired ptosis, such as:
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Tumor
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Horner Syndrome
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Myasthenia Gravis
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Stroke
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External Ophthalmoplegia
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Stye
Treatment
History of Treatment
The first description of suspending the eyelid to the brow with absorbable catgut sutures was made by Dransart in 1880. (An absorbable catgut suture is a type of medical device used to hold certain body tissues together, made from dried, twisted, usually sheep and cow intestines). Many others attempted to improve on this method by altering the material or procedure, and the first indication of the modernized treatments we use today began to appear when Tillet and Tillet (1966) suggested the use of silicone rod slings. Earlier treatments for ptosis involved excising the excess skin on the upper eyelid. They assert that the lagophthalmos linked to ptosis is significantly reduced as a result of the increased elasticity offered by their modified silicone rods (Koka & Patel, 2023b).(Lagophthalmos is the medical word for when you cannot close your eyelid completely).
Treatments Today
There are two main types of ptosis correction techniques that are most commonly used, levitator muscle tightening and frontalis suspension.
Levator Muscle Tightening
There are two different kinds of this method. It can either be external or internal.
-The internal approach
The levator or Mueller's muscle is shortened by the surgeon during the internal procedure, which involves turning the upper eyelid inside out (Koka & Patel, 2023b). The surgeon usually shortens the Mueller's muscle when less elevation of the eyelid is required (Ptosis Surgery, n.d.)
-The external approach
The levator muscle is accessed during the external ptosis repair procedure by the surgeon making an incision into the upper eyelid skin, usually in the crease. The levator muscle is then repositioned behind the eyelid and sewn to connective tissue to form a stronger adhesion (Koka & Patel, 2023b).
Frontalis Suspension
The levator and frontalis muscles hold up the eyelid, and during this procedure, an eye surgeon attaches a small silicone rod to the frontalis muscle under the upper eyelid (Brown, 2024).
Barriers to Treatment
One of the biggest barriers to treatment of any kind is the money involved. Especially in countries where health care is expensive, like the U.S., you might have to pay 10% to 20% of the surgery's overall cost. The price range can also vary depending on the severity of the condition. This is a huge setback from many attempting to correct their ptosis.
However, this is not the only barrier to accessing ptosis treatment. According to Richard’s Pre-operative experiences and post-operative benefits of ptosis surgery: A qualitative study., former ptosis patients stated that they were discouraged from seeking surgery because they did not know that ptosis was a treatable condition, they thought it was vain to care about their appearance, and they thought that ptosis surgery was the same as cosmetic surgery (Richards et al., 2017b). Mostly, these assumptions came from the lack of awareness about ptosis in the global community, which is part of the reason why finding specialists to treat ptosis is so challenging. This is why one of the main reasons of the creation of Ptosis-Perfect is to spread recognition of ptosis around the world.
Bibliography
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Brown, K. (2024, September 24). Ptosis Surgery (Droopy Eyelid Repair): Procedure & Costs. Vision Center. https://www.visioncenter.org/surgery/ptosis-surgery/.
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Koka, K., & Patel, B. C. (2023b, July 10). Ptosis correction. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK539828/
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Ptosis surgery. (n.d.). NYU Langone Health. https://nyulangone.org/conditions/ptosis/treatments/ptosissurgery#:~:text=When%20you%20need20less%20of,which%20is%20best%20for%20you.
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Richards, H. S., Jenkinson, E., Rumsey, N., & Harrad, R. A. (2017b). Pre-operative experiences and post-operative benefits of ptosis surgery: A qualitative study. Orbit, 36(3), 147–153. https://doi.org/10.1080/01676830.2017.1279669
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Jones, D. (2022b, September 22). Ptosis Surgery Cost and Procedure Guide. Medbelle. https://www.medbelle.com/face-surgery/ptosis-surgery/