Eyelid ptosis or drooping of the upper eyelid is most commonly caused by stretched, detached,
or a dystrophy of a muscle that lifts the eyelid called the levator muscle.
The word “levator” is like the word, “elevator”, but without the letter “e”.
In addition to these common causes of ptosis, which are generally limited to the levator
muscle, there is another category called neurogenic ptosis.
Neurogenic ptosis is a condition where the cause of the eyelid droop is related to the
nerves which send signals to the muscles that determine your eyelid’s position.
As is important in all areas of medicine, an accurate diagnosis is critical to a successful
treatment strategy.
I’ll discuss different causes of neurogenic ptosis, and the ways these conditions may
be addressed.
I’m Dr Amiya Prasad.
I’m a Diplomate of the American Board of Cosmetic Surgery and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I’ve been in practice in New York City and Long Island for over 25 years.
I specialize in eyelid ptosis correction surgery such as levator muscle advancement for age
related ptosis and levator muscle resection and frontalis sling for congenital ptosis.
I also specialize in performing ptosis surgery from behind the eyelid such as Mueller’s
muscle resection.
This approach allows for expedited healing since no external incision is made if there
isn’t any excess skin.
In the cosmetic field, I’ve recognized for years that eyelid ptosis is frequently overlooked
when cosmetic eyelid surgery is performed.
This oversight can result in the patient still looking tired despite having undergone upper
eyelid blepharoplasty.
In my practice, I routinely perform ptosis surgery for patients who come for cosmetic
eyelid surgery to help my patients’ eyes look brighter and less tired.
When I’m seeing a patient who has ptosis in my office, and I suspect a possible neurologic
cause, I think about three conditions: 1) myasthenia gravis 2) Horner’s syndrome and
3) third nerve palsy.
Myasthenia gravis is an autoimmune disease characterized by weakening and fatigue of
muscles in different areas depending on the type of myasthenia gravis.
Myasthenia gravis can also affect the muscles responsible for eye movement.
This means that in addition to eyelid ptosis, the patient can also experience double vision.
Horner’s syndrome is the disruption of nerve pathways from the brain to the eye, affecting
one side of the body which can result in eyelid ptosis.
Horner syndrome is most often associated with conditions such as stroke, spinal cord injury,
or the presence of a tumor.
In some cases no underlying cause is determined.
Horner syndrome also affects the eye, where the pupil is small and doesn’t open under
low light conditions.
In addition, there is an absence of perspiration on one side of the face.
The triad we’re taught in medical school is ptosis, miosis and anhidrosis.
Since Horner syndrome is most often caused by another medical condition, treatment is
most often focused on the underlying cause.
Third nerve palsy occurs when the third cranial nerve, also called the oculomotor nerve, has
been compressed, or does not get adequate blood flow, affecting movement in the upper
eyelid and the eye muscles.
In addition to ptosis, the eye is misaligned, so it appears to be looking down and outward.
The sudden onset of this condition can be a medical emergency because of the presence
of an aneurysm in the brain.
In my practice, if I see a patient who I suspect has a neurogenic ptosis, I work with a neuroophthalmologist
to perform the full diagnostic workup as well as any medical treatment.
Once this is completed, I’ll perform the appropriate eyelid ptosis surgery.
We perform eyelid ptosis surgery with local anesthesia and LITE IV sedation.
In some situations, I’ll perform surgery and have my patients sit up to confirm successful
elevation.
Patients go home the same day as surgery and return to work in 1 week or less depending
on the type of surgery performed.
In conclusion, it’s important to diagnose and manage neurogenic ptosis appropriately.
Once appropriate medical management is completed, ptosis surgery to help people see better and
look better can be performed.
I hope you found this information helpful...thank you for your question