Frequency | Ptosis

Frequency

A congenital ptosis is very rare and usually unilateral, but not further quantified in the literature. The frequency of ptosis forms of other causes depends on the disease causing it (ptosis)

Causes of ptosis

The causes of ptosis are manifold. They may be congenital or may have developed in the course of life, which is called acquired. In the following the congenital and acquired causes are described.

Congenital causes of ptosis (ptosis congenita) can either be caused by the nervous system or by the muscles. Structures in the core area of the nerve that innervates the eyelid retractor muscle may be missing. On the other hand, the eyelid lifter muscle itself may have a malformation that causes ptosis.

The acquired causes outweigh the congenital ones. Here it can happen that the nerve that supplies the eyelid lifting muscle shows a slight paralysis. As a result, the muscle is not sufficiently stimulated, which affects the lifting of the eyelid.

Age-related tissue changes can also occur, which can also weaken the eyelid lifting muscle. Furthermore, there are probably also neuromuscular diseases, such as myasthenia gravis or myotonies, which can trigger the disease pattern of ptosis. In myasthenia gravis, the interface between muscle and nerve is disturbed.

Myotonies describe a delayed relaxation of the muscles, which leads to a pathologically prolonged muscle tension. In addition, ptosis can also be caused by trauma, such as after violence or accidents. Ptosis is also a symptom in the symptom complex of the so-called Horner’s syndrome: Here, damage is present in the sympathetic nervous system, which is a part of the autonomous nervous system.

Since ptosis is the actual symptom, behind which a variety of disorders and diseases can be hidden, the question arises at this point as to which symptoms occur together, which in their combination and after anamnestic questioning of the patient provide information about the cause.In addition to the external appearance of the drooping eyelid (ptosis), the patient may have a disturbing feeling due to the eyelid resting on the eyeball. Vision may be partially or completely impaired on one eye. The danger of the development of weakness of vision due to ptosis existing from birth has already been mentioned.

Finally, the cosmetic impairment of the patient is also a significant consequence of the disease. Further diagnosis of ptosis can be followed by a blood test to clarify an autoimmune or genetic cause as well as to detect tumor markers. Ultrasound, for example from the thyroid gland, can clarify its enlargement or show a dissection in the carotid artery.

X-rays of the spinal column and chest provide information about a possible fracture of the vertebral body or a tumor at the tip of the lung (Pancoast tumor). Computer tomography or magnetic resonance imaging can be used to find skull fractures, infarction events, bleeding or soft tissue processes such as inflammation. The treatment of ptosis must be based primarily on its cause and the extent to which the patient is affected.

For example, congenital ptosis congenita, in which the eyelid lifter muscle is not fully functional from birth, can only ever be corrected by surgery. Here, the position of the eyelid must be corrected in a short surgical procedure and the defective muscle may have to be shortened slightly. This helps to improve the drooping of the eyelid and thus a reduced vision.

This type of surgery is also necessary if the muscle has been permanently damaged by other processes and an improvement of the situation is ruled out by itself. During the operation there is a risk of shortening the eyelid or the eyelid lifting muscle too much, so that a complete closure of the eyelid is no longer possible afterwards and the eye always remains a small gap open. Since this can lead to increased drying of the eyes in the long term and thus to damage to the cornea, a second corrective intervention is often unavoidable.

In the case of systemic diseases such as myasthenia gravis, it is also possible to influence the course of the disease with medication and thus combat ptosis. However, this is only promising if the nerve of the eye lifter muscle has not yet been irreversibly damaged in its course. Surgical correction of ptosis becomes necessary if the affected eyelid covers the eye so severely that vision with both eyes simultaneously (so-called binocular vision) is no longer possible or only possible to a very limited extent.

This is usually the case with congenital ptosis or ptosis where a complete loss of the eyelid lifter muscle has occurred due to a traumatic event. The procedure itself can be performed either under general or local anesthesia. The aim of the operation is to return the eyelid to its original position and thus widen the eyelid gap.

Depending on the findings of the patient, the physician has various procedures available. If it is only a slight ptosis, it is also sufficient to cut out a narrow strip in the area of the rear upper eyelid and then to suture the wound again. This shortens the eyelid as a whole, but the eyelid lifting muscle itself remains untouched.

However, if the ptosis is more severe, a small piece of the muscle must also be removed, usually between 10 and 22 millimeters. In very serious cases, the surgeon can also attach the eyelid retractor muscle to one of the muscles of the forehead (a so-called frontalis suspension). This enables the patient to lift the eyelid by moving the forehead after the procedure.

If ptosis already occurs in infancy or toddlers, the possible causes should be investigated first. If, as in most cases, it is congenital ptosis congenita, a specialist must assess how pronounced it is and how severely the child’s vision is impaired. The rule of thumb is: if more than two thirds of the pupil is obscured, binocular vision is no longer adequate and the child would inevitably develop a visual defect (so-called ambylopia) over time.

Therefore, in such cases it is necessary to correct the ptosis surgically at an early stage so that the child’s eyes are not impaired in their development.It is of course also conceivable that other space-consuming processes, such as an intracranial tumor or the like, may press on the eyelid lifter muscle or the nerve supplying it and thus lead to a failure. Here, too, a surgical intervention is recommended. If, however, the ptosis is not as severe and the child is not further affected by it in his or her daily life, it is sufficient to observe the eye and wait to see whether the ptosis may increase over time.

The principle of acupuncture is based on the fact that certain energy currents in the body, invisible to the eye, run in lines, the so-called meridians. If the flow of energy along these lines is disturbed, illnesses will result. Accordingly, according to the idea of acupuncture, a drooping eyelid is based on a faulty flow of energy in the facial area. By inserting small, fine acupuncture needles, an attempt is now made to direct the energy flow back into its correct path. There is no guarantee of success for this procedure (therefore it is not paid for by health insurance companies), but in individual cases an improvement of the symptoms is reported.