Ptosis

Ptosis is a condition in which the upper eyelid is drooping. When the upper eyelid droops, vision is impaired and disturbs appearance. There are two main causes of ptosis; congenital and acquired.

1.Congenital Ptosis

This type of ptosis is present from birth. It is often caused by an innate weakness in the muscles that raise the eyelids. The drooping eyelid often causes the child to lift his or her chin and eyebrows to look at objects. Treatment is surgery but for pediatric patients who require hospitalization, we will refer them to a nearby facility. Adult patients with congenital ptosis can be operated on in our clinic. Surgical procedure involves taking out the fascia from the thigh muscle and sewing the fascia to the forehead muscle (frontalis sling) and the eyelid plate (tarsal plate) at the edge of the eyelid, to raise the eyelid with the tension of the forehead. Depending on the degree of drooping, the same procedure may be performed as for age-related ptosis without the fascia being taken.

2.Acquired Ptosis

The most common cause of ptosis is aging, which occurs when the tendon of the muscle that raises the upper eyelid stretches and is unable to perform sufficient muscle contraction. In the past, an increasing number of hard contact lens wearers had similar symptoms and underwent surgeries. It can also be triggered by surgery using instruments that open the eye. Others are caused by trauma or nerve palsy. In cases where the muscles and tendons that move the eye are functioning normally and the skin has become stretched with age (eyelid skin sagging), surgery can be performed to improve vision by cutting the skin under the eyebrows and reducing the weight on the eyelids, called a sub-brow incision. Another method is to remove the skin around the double folds of the upper eyelid. The surgical technique is determined according to the patient's symptoms. If the tendon is stretched and the muscle to open the eyelid is not functioning properly, the levator aponeurosis plication is often performed to advance the levator tendon membrane and apply tension to efficiently transmit muscle force. Depending on the severity of the condition, not only the levator aponeurosis but also the Müller muscle (MM) may be anteriorly rotated at the same time. In recent years, methods that do not rely on fascia grafting have been reported for severe ptosis.¹⁾²⁾ In our clinic, the optimal method is selected based on the patient's symptoms in combination with the fascia graft.

1) Xiaobo Zhou; Treatment strategy for severe blepharoptosis:JPRAS (2020) 73
2) Zheng -Qiang Cang; Extended Frontalis Muscle Advancement: PRS 152 5