Do you have droopy eyelids? Let's talk about Ptosis (Droopy Eyelid)!

Have you ever noticed that some people's upper eyelids droop a little, making them look sleepy? You may have experienced this yourself. This can happen to one eye, or it can happen to both eyes. In medical terms, we call this condition Ptosis . Some people also call it 'Blepharoptosis'. Don't worry, this is a very common condition. Let's talk about it all simply and clearly today.

Simply put, what is Ptosis?

Ptosis is when your upper eyelid droops down. It looks like a window shutter is half closed. The main reason for this is that the levator muscle, which helps keep our eyelids up, is not working properly. Think of it like this muscle is like a little rope that pulls our eyelids up. When this rope becomes weak or comes loose from the eyelid, the eyelid droops.

Depending on how much the eyelid droops, your vision may be affected. Sometimes the eye is partially closed, and in severe cases, the vision may be completely blocked. This can happen in just one eye, or in both eyes. Sometimes one eye may have more drooping eyelids than the other.

There are two main types of ptosis:

This condition can occur in both young children and adults. Accordingly, we divide it into two main types.

• Congenital Ptosis: This means that your baby is born with this condition. Most often, this happens because the previously mentioned levator muscle (levator muscle) does not develop properly in the womb.
• Acquired Ptosis: This is the type that occurs in adulthood. This condition can occur when the muscle weakens or separates from the eyelid due to aging, an accident, or other medical condition.

What are the symptoms of this?

Actually, the main symptom is that the eyelid appears to be drooping. But there may be several other symptoms in addition to that. Let's see what they are.

Why is this happening? What are the reasons?

The causes of ptosis vary depending on the type. As we discussed earlier, some babies are born with this condition (congenital ptosis).

Ptosis that occurs later (acquired ptosis) can have several causes. This condition can occur if the muscles that lift the eyelid or the ligaments that connect them become weak due to an accident or illness. Sometimes it can also be caused by damage to the nerves that control the eyelid.

Some of the conditions that can cause ptosis are:

• Eye lumps (Stye)
• Horner syndrome
• Myasthenia gravis - This is a disease that weakens the muscles.
• Stroke
• Tumors of the eye
• Diseases that affect the eye muscles, such as external ophthalmoplegia

What happens if left untreated?

If your child has congenital ptosis, it is very important to treat it as soon as possible. If left untreated, it can directly affect the child's vision development. It can also cause other side effects.

Mild ptosis in adults may not affect vision much, so treatment may not be necessary. However, severe ptosis can lead to serious complications if left untreated.

Possible complications due to ptosis:

• Astigmatism: A drooping eyelid puts pressure on the front part of the eye (cornea). This can change the shape of the eye and distort vision (making it appear elongated and wrinkled).
• Amblyopia (or 'Lazy Eye'): Due to vision defects such as astigmatism, the brain gradually begins to ignore the signals coming from that eye. This can lead to permanent vision loss in that eye. This is what we call 'lazy eye'.
• Chin-up position: Keeping the chin up while looking under the eyelids can cause neck problems, stiff forehead muscles, and sometimes even developmental delays.

How is this diagnosed?

Usually, a doctor can tell if you have ptosis just by looking at your drooping eyelid. If both eyes are drooping, it can be a little harder to tell.

Your doctor will perform a physical examination and will likely refer you to an ophthalmologist. The ophthalmologist will perform an eye exam and may recommend further tests if necessary.

What tests are done for this?

• Slit lamp examination: Examination of the delicate parts of the eye with a special microscope.
• Visual field testing: A test that measures your field of vision, that is, how far you can see your surroundings.
• Ocular motility (eye movement) test: Testing the function of the eye muscles by moving the eyes around.
• Tensilon test: This is a special test to check for a condition called myasthenia gravis.

What are the treatments for ptosis?

Treatment depends on how well your eyelid muscles work. Sometimes, if the condition doesn't affect your vision and you don't have any concerns about your appearance, no treatment may be necessary.

But if ptosis affects vision, appearance, or both, your eye doctor will recommend treatment. The treatment depends on whether the condition is caused by a disease or is simply a result of aging. The most effective treatment for ptosis caused by aging is surgery.

Ptosis Surgery

This is usually done by numbing the area (local anesthesia) and giving you medicine to make you feel a little drowsy (sedation). This means you are conscious, but you don't feel any pain.

There are two main surgical methods:

1. Skin incision method: The surgeon makes a very small incision in the skin of the upper eyelid. Through it, the small muscle that lifts the eyelid is found, sutured and tightened, and the eyelid is lifted up. The skin incision is then sutured again and closed.

2. Non-incisional method: In this method, the surgeon rolls the eyelid inward and tightens the muscle underneath. This does not require any incisions in the skin.

After surgery, your doctor will explain how to care for your eyes. It is important to see your doctor again a few days after surgery for a check-up.

Are there any complications in the treatment?

As with any surgery, minor complications can occur after ptosis surgery.

• Bleeding from the wound.
• Infection at the surgical site.
• Damage to the cornea of ​​the eye.
• Inability to close the eyelid completely.
• Ptosis recurs after a period of time.
• After surgery, the shape of the eyes or the amount of eyelid lift may be slightly asymmetrical (most of these will correct themselves over time).

Are there any eye drops?

Yes. There is an eye drop that is approved for some types of Acquired Ptosis in adults. This medication is called Oxymetazoline . It works by directly targeting the levator muscle and stimulating it. Some people find that using this medication helps their eyelids open better. However, to maintain this effect, you need to use this medication every day.

Can ptosis be prevented?

Congenital Ptosis cannot be prevented. Because the baby is born with that condition. Also, it is difficult for us to prevent the causes of Ptosis (Acquired Ptosis) that occur later, such as aging. Therefore, rather than preventing this, it is more important to identify it early and seek proper treatment if it occurs.

When should I see a doctor?

This is a very important question. You should definitely see a doctor, especially an ophthalmologist, in the following situations: