Acquired Blepharoptosis

Acquired Blepharoptosis – Treatment Options

Introduction
Acquired blepharoptosis (ptosis) is the drooping of the upper eyelid that develops after birth, commonly due to aponeurotic, neurogenic, myogenic, traumatic, or mechanical causes. It may impair vision, cause asthenopia (eye strain), or affect appearance and quality of life. Management depends on the underlying cause, severity of eyelid droop, and impact on visual function.

1. Non-Surgical and Medical Management

• Underlying cause treatment:

  • Neurogenic ptosis: Treat primary disorder (e.g., myasthenia gravis with anticholinesterase inhibitors such as pyridostigmine, immunotherapy, or thymectomy if indicated).

  • Horner’s syndrome: Manage underlying lesion (carotid dissection, tumor, etc.).

• Ptosis crutches (eyeglass attachments): Mechanical lifting of eyelid in patients unsuitable for surgery.

• Topical agents: Oxymetazoline 0.1% ophthalmic solution can provide temporary improvement by stimulating Müller’s muscle contraction.

2. Surgical Management (Mainstay of Therapy)

• Levator resection or advancement:

  • Used in aponeurotic ptosis (e.g., age-related levator dehiscence).

  • Resection or tightening of levator aponeurosis restores lid height.

• Müller’s muscle-conjunctival resection (MMCR):

  • Indicated in mild to moderate ptosis with good levator function and positive response to phenylephrine test.

• Frontalis sling surgery:

  • Used in severe ptosis with poor levator function.

  • Eyelid is suspended from frontalis muscle with fascia lata or synthetic material, allowing brow elevation to lift lid.

• Combined procedures: For complex or recurrent cases.

3. Supportive and Rehabilitative Measures

• Vision correction: Address refractive errors or amblyopia in pediatric or long-standing cases.

• Lubrication: Artificial tears or ointments to protect cornea in cases of incomplete eyelid closure post-surgery.

• Regular monitoring: For progression or recurrence, especially in neurogenic and myogenic cases.

4. Lifestyle and Preventive Considerations

• Avoid eye rubbing or trauma that can worsen aponeurotic ptosis.

• Early evaluation of sudden-onset ptosis to rule out neurological emergencies (stroke, aneurysm, myasthenic crisis).

5. Multidisciplinary Care

• Ophthalmologist/oculoplastic surgeon for definitive management.

• Neurologist for neurogenic causes (myasthenia gravis, Horner’s syndrome, cranial nerve palsy).

• Oncologist or vascular surgeon if ptosis is secondary to compressive or vascular lesions.