It is a very frequent malposition which goes unnoticed because patients do not try to regularly lift their eyelids to check if they can see better. It is characterized by a drooping upper eyelid. If it is degenerative or caused by aging (aponeurotic ptosis), it may be accompanied by dermatochalasis, that is, it will be necessary to put the upper lid back in place making a blepharoplasty as a combined procedure, along with the replacement of the levator aponeurosis to correct ptosis.
Ptosis origins may be aponeurotic, paralytic or neurological; traumatic and mechanical.
A patient with aponeurotic ptosis requires surgical correction, where the part or a large part of the aponeurosis which is normally attached to the tarsus at 2-3 mm from its upper margin, has degenerated, detaches from its origin, and is put back in place.
Paralytic or neurological ptosis is the result of paralysis of the third cranial nerve innervating the levator aponeurosis. It occurs in patients with uncontrolled diseases such as hypertension, diabetes mellitus, collagen disease, associated vascular diseases, Myasthenia Gravis, compressive tumors at the level of the central nervous system and/or viral.
In such cases, it is important to have a thorough neurological examination as well as blood tests and radio imaging such as MRI and/or CT scan of the orbits and/or brain.
In cases of traumatic ptosis due to tissue detachment, it is important to replace the detached tissue surgically.
In mechanical ptosis, we would solve the root cause, such as can be: eyelid and conjunctiva tumors, which make the eyelid droop by gravity causing secondary ptosis.
In the case of ptosis surgical correction, the aponeurosis of the upper eyelid is put back in place and the postoperative care and medication are the same as for blepharoplasty.