Eyelid Ptosis Causes – Learn The Signs Of Underlying Serious Condition

Our eyelids serve a few functions. One is to protect the delicate eye from dirt, debris, and even incoming projectiles such as a wayward snapped rubber band. Another function is to keep the surface of the eye well lubricated for the purposes of both eye health and good vision by containing various glands that secrete the multiple components of our complex tear film. 

When the eyelids don’t function as they should, such as with an eyelid ptosis, it can impact various aspects of our vision, such as hindering the sight out of the affected eye or inducing dry eye. Some of these cases are age-related and may simply require referral to a specialist in oculoplastic surgery while other ptosis causes are a sign of a more serious underlying disease that necessitates further medical investigation. 

 

What is an Eyelid Ptosis?

 A ptosis is the medical term for a drooping upper eyelid. The magnitude of the ptosis can vary from being only noticeable when carefully comparing the height of the eyelid to the other eye, to being severe enough such that the eye appears almost entirely closed and ptosis surgery is required to restore vision. 

 

Ptosis Causes

The most common cause of an eyelid ptosis is simply age, a condition termed aponeurotic ptosis or senile ptosis. The action of the upper eyelid is controlled mainly by a muscle called the levator palpebrae superioris, which is anchored to the surrounding tissues by a ligament. With time, age, and gravity, this ligament can stretch and loosen or become entirely detached, resulting in a limited ability to hold up the eyelid levator muscle. An aponeurotic ptosis is generally easily rectified through ptosis surgery in a procedure that aims to either shorten the levator muscle or reattach the ligament. If uncorrected with oculoplastic surgery, an age-related ptosis can worsen with time. 

most common eyelid ptosis causes melbourneIn addition to occurring in the elderly, an eyelid ptosis can also occur in the very young, as is the case in a congenital ptosis. During this condition, an infant is born with an existing ptosis, most commonly due to underdevelopment of the eyelid levator muscle. A congenital ptosis will rarely worsen with time if left uncorrected, however, if the drooping eyelid is low enough to obscure vision, the ophthalmologist will likely recommend ptosis surgery early in life to encourage proper visual development in the eye and avoid causing a lazy eye (amblyopia)

Localised diseases or conditions of the eye can also contribute to ptosis causes. These include infections of the eyelid, which causes inflammation and swelling, or the presence of some lesion that physically weighs down the upper lid, causing it to droop. Such lesions can be a simple chalazion or stye, or may be more serious such as a large tumour. Trauma to the eye area can also induce a ptosis, such as eyelid swelling from a black eye. 

Rarely, ptosis causes can be the result of a more serious disease requiring medical attention beyond an oculoplastic surgery specialist. One of these conditions is myasthenia gravis, which is an autoimmune neuromuscular disease resulting in muscle weakness. Myasthenia gravis is characterised by a worsening of muscle fatigue and weakness after periods of activity, improving after periods of rest. Often, deterioration of the muscles around the eyes may be one of the first signs of myasthenia gravis, including a ptosis but also the presence of double vision as the muscles that control the movements of the eyeballs themselves fatigue (ocular myasthenia).

When presenting with a ptosis, if the doctor suspects myasthenia, he or she may test this by asking the patient to look upward for a sustained period of time; a person with myasthenia gravis will find the ptosis worsens during this activity. Unfortunately, there is no current cure for myasthenia, but with modern medicine there are many therapies available that can effectively improve muscle function and quality of life for affected individuals. For some people, ptosis surgery can be a useful treatment in addition to medical management for the systemic disease. 

Another cause of ptosis can arise from problems with the nerves that control the eyelid muscles. The upper eyelid is innervated by the third (out of 12) cranial nerves. Any condition that affects the pathway of this nerve through the brain can result in a ptosis, including diseases such as a stroke, brain tumour, or aneurysm in the brain. Even long-term diabetes has the potential to cause nerve damage.

A rare condition known as Horner’s syndrome can present with a ptosis, double vision, and abnormally small pupil, due to damage to one section along a chain of nerves that run from the brain, down the spinal cord to the top of the lungs, and then back up the neck to the face. Causes of Horner’s syndrome that may result in a ptosis include a lung tumour, a stroke in the brainstem, birth trauma to the neck and shoulder, or injury to the carotid artery. If the doctor suspects Horner’s syndrome, ptosis surgery will not be a priority – instead, you will most likely be sent to the hospital emergency department.

Be reassured that most cases of ptosis are benign and simply a result of age. However, should you notice an eyelid progressively becoming more and more droopy, it is important to be assessed by an appropriately experienced eye specialist. 

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

retinal tear causes melbourne

Retinal Tear Causes – How They Can Be Managed?

The retina is the light-sensing tissue lining the inside of the eye. Made up of ten layers of different types of cells, the retina is crucial for vision. Any damage to this structure from trauma or disease, including a severe retinal tear, can cause permanent loss of vision in that particular part of the eye. 

 

What is a Retinal Tear?

A retinal tear is exactly as it sounds – a rip or tear in the fragile tissue of the retina. This is different from a retinal detachment, where a section of the retina peels away entirely from the underlying structures of the eye, however, it is not impossible that a retinal tear causes a detachment, which must then be treated urgently with retinal surgery

The retina contains no pain nerves and so a retinal tear causes no physical discomfort or pain. Some instances of a retinal tear may in fact present with no symptoms at all, particularly if the tear is small or very far out in the periphery of the eye where we are less aware of changes to our vision. In other cases, a retinal tear causes symptoms including: 

  • A sudden appearance of floaters in the vision of the affected eye – these can be described as little black dots or spots, or cobwebs. Some people in fact think they’re seeing a swarm of tiny black insects before realising the floating specks are inside their own eye. 
  • Flashing lights in the vision – the medical term for this is photopsia, and often appears as a lightning arc out of the corner of your eye. The flashes may be recurrent and persist for some time.
  • Hazy vision – if the tear has disrupted some retinal capillaries, the resultant bleed into the space of the eyeball can cause a blurry patch in your vision. 

If the retinal tear causes a detachment you may notice more dramatic symptoms, such as the sensation of a dark shadow or curtain falling across part of your vision and obscuring that part of your sight. If you experience this it is important to promptly seek the attention of an eye specialist experienced in retinal surgery.

 

Retinal Tear Causes

Most instances of a retinal tear are idiopathic, meaning they occur spontaneously with no identifiable underlying reason. There are certain factors which may put you at a higher risk of developing a retinal tear, including:

  • Older age
  • A family history or retinal tears or detachments
  • A history of trauma to the eye or head
  • Myopia, also known as near-sightedness or short-sightedness, as this results in a thin retina
  • Lattice degeneration, which involves thinning of areas in the peripheral retina 
  • A history of an eye operation, including cataract surgery 

One of the common retinal tear causes can be attributed to a normal age-related change called a posterior vitreous detachment (PVD). The vitreous humour is a clear jelly-like substance that fills the back chamber of the eyeball, and is anchored to certain points along the retina.

As we age, the vitreous begins to liquefy, resulting in its solid molecular structure slowly collapsing. While this process is entirely normal, occasionally the adhesion between the vitreous gel and the retina is too tight and so does not separate easily as the vitreous liquefies. The tension on this anchor point may be enough to tug so hard on the retina that it causes a tear in the tissue, or possibly even a detachment. 

An eyecare practitioner such as an optometrist or ophthalmologist will often find a retinal tear incidentally during a routine eye exam. This can be achieved by using dilating eye drops to widen the pupil and utilising an illumination and magnification system to view the retina, such as a slit lamp biomicroscope or a binocular indirect ophthalmoscope. If there is a haemorrhage obscuring part of the retina where a tear or detachment is suspected, an imaging device such as an ultrasound may be required to view the retina behind the bleed. 

 

Retinal Surgery

The main determining factor when it comes to deciding whether retinal surgery is warranted for a tear is its potential to deteriorate into a vision-threatening retinal detachment. Retinal tears that are small, peripheral, and oriented in a certain way may be deemed low-risk, and therefore can be monitored carefully without intervention. Some tears in fact self-heal by naturally forming their own scarring, thereby resealing themselves. 

If a tear is thought to have significant potential to lead to a retinal detachment, also when considering a person’s other risk factors such as the presence of high short-sightedness, the eye specialist may recommend either a laser procedure called photocoagulation or a freezing technique known as cryopexy in order to seal the edges of the tear to prevent it from deteriorating.

In a way, both these treatments function like spot-welding, creating microscopic patches of controlled scarring that re-stick the torn retina to the underlying tissue. Photocoagulation is done under a topical anaesthetic in the ophthalmologist’s office and only takes several minutes. There is very little recovery time required afterward, if any at all, and many people resume their usual activities immediately. In the case of cryopexy, there may be a period of recovery over a couple of weeks.

It’s important to understand that successful treatment for a retinal tear doesn’t preclude you from experiencing another tear, either in the same or opposite eye. Your eye specialist will recommend you maintain regular and frequent eye exams with your eyecare practitioner. 

 

 

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.