Should i worry about ptosis

Often the problem affects your appearance and nothing more, but in other cases it may interfere with vision or cause eye irritation. Blepharitis is inflammation of the eyelids. It can be caused by a problem with the oil glands near the base of the eyelids, a bacterial infection, or skin conditions like rosacea or seborrheic dermatitis dandruff of the scalp and eyebrows.

Though blepharitis usually doesn't affect your sight, it can make your eyelids red, itchy, and swollen and leave your eyes red and watery. Your ophthalmologist might recommend treatments like artificial tears or a short course of steroid eye drops to relieve discomfort from blepharitis.

You'll also get treated for the cause of the problem, for example, with anti-dandruff shampoo or antibiotic eye drops. It also helps to regularly clean your eyelids with a warm washcloth. Over time, the upper eyelids may start to sag as the muscles that support them lose their strength. Eye injury, nervous system problems, and disease such as diabetes or myasthenia gravis can also cause this condition.

Botox injections to eliminate wrinkles in the brow and forehead may also cause drooping, which can last as long as three months. Although upper eyelid drooping is often only a cosmetic concern, it can interfere with sight if the lid is so lax that it covers or partially covers the pupil. Before trying any treatment, you will need a medical exam to identify the cause.

If a disease caused your ptosis, the drooping usually improves when the disease is treated. If the problem is caused by Botox injections, it should resolve in about three to four months when the injection wears off.

If a droopy eyelid is unattractive or interferes with your vision and is not caused by a treatable disease, you may want to consider surgical repair. The ptosis repair procedure removes excess tissue and lifts the lid. It can be performed under local or general anesthesia on an outpatient basis. Many health insurers will cover this operation, but only if the ptosis affects your vision.

Your ophthalmologist or oculoplastic specialist can determine whether you qualify for coverage. When eyelid skin loses elasticity and sags, it creates new folds that can droop over the lashes and block the upper field of sight by covering the pupil.

In blepharochalasis, just the skin of the lid begins to droop, not the entire lid as in ptosis which is caused by muscle weakening. A surgical procedure called blepharoplasty can correct this condition. Editorial team. Causes A drooping eyelid is most often due to: Weakness of the muscle that raises the eyelid Damage to the nerves that control that muscle Looseness of the skin of the upper eyelids Drooping eyelid can be: Caused by the normal aging process Present before birth The result of an injury or disease Diseases or illnesses that may lead to eyelid drooping include: Tumor around or behind the eye Diabetes Horner syndrome Myasthenia gravis Stroke Swelling in the eyelid, such as with a stye.

Symptoms Drooping may be present in one or both eyelids depending on the cause. Problems with vision will often be present: At first, just a sense that the very upper field of vision is being blocked.

When the drooping eyelid covers the pupil of the eye, vision may become completely blocked. Children may tip their head back to help them see under the eyelid. Tiredness and achiness around the eyes may also be present. Exams and Tests When drooping is on one side only, it is easy to detect by comparing the two eyelids.

Tests that may be performed include: Slit-lamp examination Tensilon test for myasthenia gravis Visual field testing. Treatment If a disease is found, it will be treated. Eyelid lift surgery blepharoplasty is done to repair sagging or drooping upper eyelids. In milder cases, it can be done to improve the appearance of the eyelids. In more severe cases, surgery may be needed to correct interference with vision. In children with ptosis, surgery may be needed to prevent amblyopia , also called "lazy eye.

Outlook Prognosis A drooping eyelid can stay constant, worsen over time be progressive , or come and go be intermittent. When to Contact a Medical Professional Contact your health care provider if: Eyelid drooping is affecting your appearance or vision. One eyelid suddenly droops or closes.

Any patient presenting with unilateral ptosis is suspected of having Horner syndrome oculosympathetic paresis until proven otherwise. It is extremely important to document not only the reactivity of the pupils, but also the size of the pupils. Figure 1. Acute right ptosis and miosis in a patient with Horner syndrome.

Because of the high incidence of both physiologic anisocoria and ptosis, statistically patients with these two findings will present to the ophthalmologist much more often than patients with true HS.

If anisocoria is present, pupillary size should be measured in both light and dark conditions. The relative anisocoria will remain the same if is physiologic, and will increase in darkness in patients with HS because the miotic side will not dilate as quickly due to sympathetic nerve damage.

Two additional clues should be sought. First, check for dilation lag during pupillary exam. In HS, the affected pupil will continue to react briskly to light, but dilate more slowly than the unaffected side. Second, always check the position of the lower lid. A finding of conjunctival hyperemia is helpful when present, but tends to be transient. If HS is established, the one most important point to document is the presence or absence of pain headache, brow ache, forehead tingling, neck pain.

The full history should elicit:. A recent study concluded that in most cases of HS, a careful history will lead the clinician to the etiology. If Horner syndrome is suspected, there are two choices: pharmacologic testing or neuroimaging.

The bottom line is that regardless of the outcome of pharmacologic testing, the majority of patients with new-onset HS will require imaging. Although cocaine and hydroxyamphetamine may be available in many neuro-ophthalmology clinics, these agents are difficult to come by in other offices or emergency rooms, and many would argue that hydroxyamphetamine has become a relatively useless test in the diagnosis and management of HS. Apraclonidine 0. Figure 2. Left: A patient with acute, right Horner syndrome and headache.

Right: Following instillation of cocaine drops in both eyes, note the absence of pupillary dilation in the affected eye. In cases of HS, apraclonidine instilled in both eyes will result in a slight mydriasis of the affected side and a miosis of the unaffected side i. However, because apraclonidine relies on the presence of denervation hypersensitivity, which may take weeks to develop, a negative apraclonidine test in acute or subacute situations does not effectively rule out the possibility of HS.