Simply put, ptosis or blepharoptosis is merely a positioning of upper eyelid that is lower than it should be. It is simple to define, but is it equally easy to live with? There is a 50% chance that ptosis may or may not bother you clinically, but a 100% guarantee that it can affect you cosmetically, thus making ptosis treatment a must.
How can ptosis affect us?
Ptosis or droopy eyelids can affect us in multiple ways both cosmetically and physically. A few of them are:
- A lower-set eyelid may sometimes cover a part of the pupil obstructing the visual field.
- Decreased vision may be accompanied by an excess work pressure on the eye to compensate for the blocked vision leading to ocular strain and fatigue. A constant effort to elevate the lids by raising the brow can give an additional headache.
- Unilateral or one-sided ptosis may unknowingly cause one to tilt the head on one side for a symmetric vision and this can precipitate neck strains and ache.
- A risk of developing amblyopia or lazy eye in kids suffering from unilateral droopy eye.
- A tiring or sleepy look with a continuous stretch of forehead muscles to combat ptosis, making one look angry, exhausted, stressed and even inattentive.
All its clinical implications necessitate treatment. Fortunately, ptosis is resolvable by both non-surgical or by ptosis correction surgery depending on severity.
Types of ptosis treatment
The most important thing when it comes to ptosis treatment is to not treat the cosmetic effect, but to treat the cause. Once the cause of the problem has been managed, the next best possible and long-term management of ptosis is through a surgery called blepharoplasty.
There are also intermediary solutions for those who are not willing to or are unsuitable for surgical interventions.
Non-incisional Ptosis Treatment
Quite effective for mild grade drooping these remedies include the following:
Exercises like quick, forcible eye rolls, yoga, etc. though cannot cure ptosis but can improve the strength of weakened muscles and impart a lifted appearance to the sagging brows and eyelids. If the ptosis is caught in an incipient phase, exercise may prevent further worsening.
Stimulation of the muscle with a stimulating device, such as back of electric toothbrush, can be a good exercise to the muscles.
Chemical lift with Botulinum Toxin Type A
Botulinum toxin injections is an FDA-approved technique used for facial upliftment. If done perfectly, it can successfully elevate a drooping eyebrow and consequently lift the corresponding eyelid by 1-2 mm, which can be of great help in mild ptosis.
Though the results are quick and adequate, they are usually temporary (3-4 months), need repeated lifts at regular intervals and expertise of the aesthetic doctor as even a minor error can aggravate drooping instead of treating it.
External medical devices
Skin-taping or adhesives can mechanically lift or hold the eyelids in place by sticking them to the forehead skin. Though inexpensive and easy to use, the disadvantage is that the tape must be applied daily, and efficacy is largely user-dependent, restrict the natural blink reflex and may even cause dry eyes.
Spectacle-based lid crutches or ptosis crutches
Here, props or supports are attached to the regular spectacle frames positioned at or just above the eyelid crease. These props retract and hold the eyelid up and prevent drooping. These are typically ideal for patients who are poor surgical candidates or those with temporary or fluctuating symptoms.
Limitations for this ptosis treatment may include discomfort, restricted blink causing dryness, the requisite cleaning regimen, and risk of damage to the globe in an accident.
Haptic contact lens
This is a scleral contact lens which can lift the upper eyelid with the bulk of the lens itself, or with a shelf attached on which the upper eyelid rests. They come with the benefit of trapping tears and corneal surface protection, but can cause discomfort and need meticulous lens hygiene.
Magnetic levator prosthesis (MLP)
Latest addition to the non-surgical ptosis aids wherein the eyeglass frame is made of magnet and a magnetic material is placed on the eyelid. When the specs are on, the lid is suspended by the magnetic field and pulled open. The force allows a blink when desired, reanimating the lid.
These medical devices can lift the eyelids temporarily and relieve the symptoms only if they are in use, but they do not address the primary cause of droopy eyes.
Moreover, it should be kept in mind that the non-surgical methods are not an alternative to surgery, nor are they as effective as surgical management. Instead, these methods are temporary and not suitable for congenital or severe forms of ptosis.
Ptosis Treatment: Blepharoplasty
This is a well-established surgery where the plastic surgeon tightens the muscles to lift the droopy eyelids to a desired level. Some advantages of blepharoplasty or ptosis correction includes:
- A one-time long-term solution to all types of ptosis
- Only solution for congenital as well as moderate (3-4mm) to severe (>4mm) forms of ptosis.
- Good results with very minimal post-op care needed
Similar to blepharoplasty, ptosis correction is a delicate surgery wherein a well-trained oculo-plastic surgeon creates an incision in the eyelid crease, reaches out to the levator muscles, repairs an injury or defect if any, tightens the muscles or resect and reattach the muscle to give the eyelid a desired lift. He also removes any excess skin or fat or tissue if present.
The incision is then scrupulously closed to mimic a natural crease. The end result is usually bigger eyes, improved field of vision, and a more attentive, fresher look.
What is a sling operation?
A sling operation is done only when the levator muscles are either poorly developed, badly damaged, irreparable or extremely weak. With this technique, the eyelids are raised with the help of the forehead muscles.
Consider the best option for ptosis treatment based on your condition
A ptosis correction surgery will not only improve your vision, greatly, patients also find that their appearance improved significantly as well.
Be sure to consult a board-certified and well-trained plastic surgeon about your options for ptosis treatment.