Blepharoptosis: Description, Causes and Risk Factors: ICD-10: H02.40. Drooping of the upper eyelid. Blepharoptosis is one of the most common eyelid disorders encountered in Ophthalmology. In this condition, the border of the upper eyelid falls to a lower position than normal. In severe cases, the drooping eyelid can cover all or part of the pupil and interfere with vision. Blepharoptosis can affect one or both eyes. It may be present at birth (congenital blepharoptosis), or it may develop gradually over decades. Sometimes blepharoptosis is an isolated problem that changes a person's appearance without affecting vision or health. In other cases, however, it can be a warning sign that a more serious condition is affecting the muscles, nerves, brain or eye socket. Blepharoptosis that develops over a period of days or hours is more likely to signify a serious medical problem. There are many potential causes of blepharoptosis, including: Blepharoptosis Inherited defects or defects present at birth.
  • Old age: In this case, the muscles grow weaker and there is a loss of eyelid support that gradually occurs over time.
  • Muscle weakness or damage: This may be due to inherited muscle diseases, the use of certain topical medications to the eye, or myasthenia gravis (MG). MG is a condition that causes muscle weakness in most of the body because a person's immune system attacks the muscles.
  • Damage to one of two nerves that attach to the upper eyelid muscles: This nerve damage can be present at birth or can happen later in life.
Possible causes of acquired nerve damage include: Diabetes.
  • High blood pressure.
  • Tumors or cancer, which may be inside the skull or in the neck or lung.
  • Injury.
  • An abnormally widened artery inside the skull, which is a potentially life-threatening problem.
  • Inflammation of the nerve, such as from an infection or from the immune system attacking the nerve for unknown reasons.
Good control of diabetes and high blood pressure can prevent some cases of a drooping upper eyelid. Lung cancer is a fairly uncommon cause of a drooping eyelid. This disease can usually be prevented by not smoking. Many cases cannot be prevented. Symptoms: Drooping eyelid is usually noticed by the affected person, or the parents of an affected child. The affected eye is usually less open than the normal eye, although the condition can occur in both eyes. Drooping may be the only symptom. All other symptoms are related to the underlying cause. In cases of nerve damage, blurry or double vision may occur and the pupil may be abnormally small or large compared to the other eye. If muscle weakness is the cause, there may be muscle weakness in other areas of the body. Diagnosis: Your health care provider will get a medical history and perform a physical examination. Medical history questions may include: How long has this been present?
  • Are both eyelids affected or just one?
  • Is it getting worse or staying the same?
  • Is it present all of the time or only sometimes?
  • What other symptoms do you have?
The physical examination may include a detailed assessment of nerve functioning. Diagnostic tests that may be performed include: Slit-lamp examination.
  • Tensilon test.
Treatment: Acquired ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. Surgery is designed to reattach the stretched muscle to its normal location. If there is poor strength in the levator muscle, an implant known as a "sling" may be implanted to aid in the elevation of the droopy eyelid. Congenital ptosis is also treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. If the ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age during the preschool years. Many surgical techniques have been described for the repair of ptosis. The ptosis surgeon should be comfortable with a variety of different techniques. This allows for the selection of the most appropriate technique for each individual patient. Types of surgical procedures may include: Tarsomyectomy (Fasanella-Servat Procedure).
  • Posterior Muller's Muscle/Conjunctival Resection (Putterman Mullerectomy Procedure).
  • Levator Aponeurotic Advancement Procedure.
Risks and benefit of the surgery must be discussed with your ophthalmologist. NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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