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Ptosis

  PTOSIS is the medical term for a noticeable droopiness of the upper lid.It has many possible causes:
  
1. AGE. This is the most common setting in which this entity is seen.The muscles which elevate the eye stretch and become thinned as we age; the result is loss of muscle tone and an inability to raise the upper lid well.It effects both eyes, but often one eye appears worse than the other. Eye surgery, such as cataract removal, may aggravate this form of PTOSIS.
   2. CONGENITAL. Noticed at birth or shortly thereafter, congenital PTOSISis produced by a developmental abnormality in the muscles which elevate theupper lid. Three quarters of the time it effects only one eye.
   3. INJURY. Automobile accidents in which passengers are hurled through the windshield often damage the delicate structures around and in the eye.Lacerations, burns and chemical injuries may also cause this droopiness.
  4. NEUROLOGICAL DISEASES. These are rare but must be diagnosed properlyto avoid unnecessary surgery until the timing is right.
   Symptoms are both cosmetic and functional. Difficulty reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well.In newborns it is essential that this problem be addressed and treated properly to insure normal maturation of the visual system and the avoidanceof amblyopia (lazy eye).
  TREATMENT is surgical. There are a variety of approaches to the lid. The goal is to elevate the lid to match the other side with a minimum of scars and side effects. The most discussed complication is "overdoing it" with resultant inability to close the eye completely after surgery. This creates a dry eye situation which may be difficult to manage.In the age related form, almost invariably the unoperated eye will appear lower after a successful repair of the first eye. This is a BILATERAL condition, and this drooping in the unoperated eye is to be expected.The condition is commonly confused with dermatochalasis.

© nholland 2002