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Ptosis

Ptosis is the medical term for drooping eyelids. It occurs when the upper eyelid droops to an abnormal level and covers part of the eye, restricting or obscuring vision. Ptosis can be present in children or adults.

Cause-
1. Normal aging process- The muscles that elevate the eyelid stretch and become thinned out and resulting in a loss of muscle tone and the inability to hold the upper lid in the proper position above the eye.
2. A congenital abnormality (present before birth)
3. The result of an injury or disease.
Risk factors include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, and a brain tumor or other cancer, which can affect nerve or muscle reactions.
Classification
Depending upon the cause it can be classified into:
  • Neurogenic ptosis which includes oculomotor nerve palsy, Horner's Syndrome, Marcus Gunn jaw winking syndrome, IIIrd cranial nerve misdirection.
  • Myogenic ptosis which includes myasthenia gravis, myotonic dystrophy, ocular myopathy, simple congenital ptosis, blepharophimosis syndrome
  • Aponeurotic ptosis which may be involutional or post-operative.
  • Mechanical ptosis which occurs due to edema or tumors of the upper lid
  • Neurotoxic ptosis which is a classic symptom of envenomation by elapids such as cobras, or kraits. Bilateral ptosis is usually accompanied by diplopia, dysphagia and/or progressive muscular paralysis. Regardless, neurotoxic ptosis is a precursor to respiratory failure and eventual suffocation caused by complete paralysis of the thoracic diaphragm. It is therefore a medical emergency and immediate treatment is required.
  • Pseudo ptosis due to:
    1-Lack of lid support:Empty socket or atrophic globe.
    2-Higher lid position on the other side: As in lid retraction
Symptoms-
The primary symptom of ptosis is a drooping eyelid of one or both eyes.
1. Children who are born with a ptosis usually tilt their head back in an effort to see.
2. Difficulty in reading and while driving are common complaints.
3. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well.
4. Difficulty closing the eye completely.
5. There maybe increased watering of eyes.
6. Crossed or misaligned eye and sometimes double vision occurs.
7. Eye fatigue from straining to keep eye(s) open.
Treatment-
If an underlying disease is found, the treatment will be specific to that disease. Most cases of ptosis are associated with aging and there is no disease involved.
Surgery can be done to improve the appearance of the eyelids in milder cases if the patient wants it. In more severe cases, surgery may be necessary to correct interference with vision. In children with ptosis, surgery may be necessary to prevent amblyopia.
Prognosis-
The expected outcome depends on the cause of the ptosis. Surgery is usually very successful in restoring appearance and function.

Role of homoeopathy
Homoeopathy has shown its efficacy in improving the power and tone of muscles. However, it may be noted that the improvement with homoeopathy may not be as fast as surgery. The role of homoeopathy is more of a long term control, rather than for acute crisis control. Homoeopathy with its constitutional approach works at deeper levels to cure the problem.

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