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Ptosis of the eyelid (drooping of the upper eyelid)

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Eyelid Ptosis (Drooping of upper eyelid)

The upper eyelid drapes over the eye to protect and help keep the surface moist. Closed, the eye may be protected but you cannot see very much through the eyelid. To see you must lift the upper lid out of the way. The levator muscle performs most of the work to get the upper eyelid out of the way for vision. Ptosis of the eyelid means that it droops too low and cannot get out of the way enough for the eye to see. Elevation may be just enough for gaze towards the lower visual fields (towards the feet). Looking straight ahead, the lid may obstruct vision. In this first case (congenital simple ptosis), the upper lid covers half of the pupil. This patient compensated by lifting her eyebrow (frontalis muscle) to help with vision when looking up. As the day progressed and she tired, the lid got more and more in the way. Her problem has been there since birth.

Simple Congenital Ptosis Upper Eyelid - Gaze Ahead

Before surgery	After surgery

Before surgery see how the patient's left eyelid covers half of her pupil (Ptosis). The fold in the upper lid is much higher than the normal eyelid. The levator muscle was shortened through an incision along the inner surface of the lid. After surgery the lid no longer obstructs vision on direct ahead gaze.

Simple Ptosis Upper Eyelid Gaze Down

Before Surgery

Before surgery this patient had enough function of her levator eyelid muscle to have no obstruction her vision when looking down.

Simple Ptosis Upper Eyelid - Gaze Up

Before surgery	After surgery

Before surgery when looking up, the pupil was completely covered even though she tried to compensate by lifting her left eyebrow. After surgery the readjusted levator muscle permits vision when looking up.

Simple Ptosis Upper Eyelid After Surgery

Looking Up	Looking Down

Notice how the patient can look up after surgery without resorting to using her eyebrow muscle (frontalis muscle).Myogenic ptosis (the muscle only partially connects the the upper eyelid).This movie of another patient is 140K and may take some time to load. This is a patient with right upper eyelid ptosis. Notice how the right lid moves, just not enough to uncover the eye. The eyebrow muscle (frontalis muscle) tries to compensate to open the eyelid without success. After closing her eyes, the eyebrow relaxes and returns to a resting position.

Posted at the request of Dr. Engle: Research is underway to identify the genetic defect causing simple congenital ptosis. If more than one member of your family was born with ptosis and your family is interested in participating in this study (with no associated financial cost to you), please contact Dr. Elizabeth Engle by E-mail. Please note, Dr. Engle's lab is studying simple ptosis not associated with the blepharophimosis syndrome: engle@rascal.med.harvard.edu Elizabeth C. Engle, MD Assistant Professor of Neurology, Harvard Medical School Neurology and Genetics, The Children's Hospital Enders 512, 300 Longwood Avenue, Boston, MA 02115

 

Other topics of interest:

Ptosis of the eyelid (dropping of the upper eyelid).
Ptosis classification
Muscle function and dysfunction in drooping eyelid problems.
Measuring eyelid function in eyelid ptosis.
Congenital eyelid ptosis reconstructive surgery options.
Recurrent congenital eyelid ptosis in a 26 year old black male.
Ptosis associated with paralyzed eyebrow muscle.
Ptosis associated with Blepharophimosis (congenital eyelid deformity).
Blepharoplasty (Cosmetic surgery of the eyes)
Ectropion (Drooping of the lower eyelid) Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts. Reconstruction of the lower eyelid

 

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