Ptosis Treatment Program

Ptosis, medically referred to as blepharoptosis, is a condition marked by the abnormal lowering of the upper eyelid margin, which can affect one or both eyes and vary in severity. While some cases are subtle and primarily aesthetic, more advanced ptosis can significantly impair visual function by obstructing the superior visual field, leading to functional blindness in severe cases. Beyond limiting vision, the drooping eyelid can create compensatory habits such as forehead muscle overuse or chin elevation, contributing to chronic strain, fatigue, and postural imbalances. The condition may also interfere with the natural blinking mechanism, compromising the distribution of the tear film and predisposing the ocular surface to dryness, irritation, and exposure-related complications. In pediatric cases, ptosis may hinder normal visual development, posing a risk for amblyopia (lazy eye) if not addressed early. Regardless of its origin, ptosis can affect both the functional and psychosocial aspects of a patient’s life. Fortunately, advancements in oculoplastic surgery offer effective corrective solutions that restore both eyelid position and ocular health, while also enhancing facial symmetry and appearance.

Why Cuba

In Cuba, ptosis surgery is performed with exceptional precision by highly trained oculoplastic and ophthalmic specialists, ensuring optimal functional outcomes alongside aesthetic restoration. The country’s medical expertise extends to advanced eyelid procedures, with surgeons employing refined techniques to safely elevate the eyelid, restore proper positioning, and enhance both vision and facial symmetry. Recognizing the potential of ptosis to impact visual fields, ocular comfort, and quality of life, Cuban surgical teams conduct thorough preoperative evaluations to assess eyelid muscle function, degree of drooping, and overall ocular health in order to determine the most suitable and individualized surgical approach.

Importance of the Eyelids

The eyelids play a vital role in maintaining ocular health by protecting the eyes, preserving moisture, and supporting normal visual function. Each blink helps distribute the tear film evenly across the corneal surface, preventing dryness, irritation, and exposure-related complications. Additionally, the eyelids act as a natural barrier against environmental irritants, trauma, and infection. When their function is disrupted, it can result in impaired vision, discomfort, and noticeable changes in appearance.

Ptosis is one common condition that compromises eyelid function. In congenital ptosis, this muscle may be underdeveloped from birth. In acquired forms, factors such as aging, trauma, or neuromuscular disorders can lead to progressive drooping of the eyelid. The onset of ptosis may be gradual or sudden, depending on the underlying cause, and its impact can range from minor cosmetic concern to significant visual obstruction.

• Visual obstruction: In moderate to severe cases, the drooping eyelid may cover the pupil, leading to restricted upper field vision.
• Eye strain and fatigue: Patients often overuse the forehead muscles to lift the eyelid, causing discomfort or headaches.
• Amblyopia (lazy eye) in children: If untreated, ptosis can hinder normal visual development and lead to long-term vision impairment.
• Dry eye and irritation: Poor eyelid closure may affect tear film distribution, leading to exposure-related dryness or discomfort.
• Facial asymmetry: Even mild ptosis can have noticeable cosmetic effects, impacting self-esteem and social interaction.
• Frequent tilting of the head backward or raising of the eyebrows: Indicates compensatory behavior to overcome vision obstruction, often resulting in muscle fatigue or neck strain.

Causes of Ptosis

Ptosis can have a variety of causes, including:

• Congenital defects in eyelid muscle development.
• Age-related weakening of the levator muscle or its tendon (aponeurotic ptosis).
• Neurological disorders, such as third cranial nerve palsy or myasthenia gravis.
• Trauma or surgical injury affecting the eyelid or surrounding structures.
• Tumours or inflammation that interfere with eyelid muscle or nerve function.
• Contact lens overuse, which may stretch the eyelid tissues over time.

Understanding the cause is crucial to determining the appropriate surgical approach and predicting outcomes.

Types and Classification of Ptosis

Ptosis is classified based on its origin and severity:

By Cause:

• Congenital Ptosis: Present at birth
• Acquired Ptosis: Develops later in life due to age, trauma, disease, or neurologic causes.
• Aponeurotic Ptosis: Most commonly acquired type, caused by aging or stretching of the levator aponeurosis.
• Neurogenic Ptosis: Resulting from nerve damage or neurological disorders.
• Myogenic Ptosis: Related to muscular disease (e.g., myasthenia gravis).
• Mechanical Ptosis: Caused by tumours or inflammation weighing down the lid.
• Traumatic Ptosis: Due to injury or surgery.

By Severity:

• Mild: Eyelid droops slightly but does not obstruct vision.
• Moderate: Partial coverage of the pupil; may affect vision under certain conditions.
• Severe: Significant drooping that obstructs vision and requires surgical correction.

Diagnosis of Ptosis

Diagnosis of ptosis involves a comprehensive eye and eyelid examination, which may include:

• Visual acuity and visual field testing
• Eyelid measurements (margin-reflex distance, levator function)
• Slit-lamp exam to assess ocular surface health
• Neurological evaluation if a nerve-related cause is suspected
• Imaging studies (MRI or CT) if an orbital mass or trauma is involved
• Tensilon test for suspected myasthenia gravis

A full diagnosis helps differentiate ptosis from other causes of eyelid asymmetry, such as dermatochalasis or brow ptosis.

Types of Procedures and Surgical Approaches

Ptosis surgery aims to lift the upper eyelid to a normal position, restore visual function, and improve appearance.

Surgery may be recommended for:

• Patients with moderate to severe ptosis affecting vision.
• Individuals with progressive or symptomatic drooping that causes discomfort or aesthetic concern.
• Children with congenital ptosis to prevent amblyopia.
• Patients with stable systemic health and realistic expectations of surgical outcomes.

Surgery may be deferred if:

• Ptosis is mild and does not affect vision or quality of life.
• The condition is related to an unstable neurological disorder.
• There is active infection, inflammation, or poor eyelid hygiene.
• The patient is medically unfit for surgical intervention.

The surgical technique used depends on the cause and severity of the ptosis, as well as levator muscle function.

Levator Advancement or Resection (Minimally Invasive to Traditional)

• Most common technique for aponeurotic and congenital ptosis.
• The levator muscle or aponeurosis is shortened or reattached to raise the eyelid.
• Can be done via a skin incision (external approach) or conjunctival incision (posterior approach).
• Minimally invasive when done internally; traditional if external approach is needed.

Frontalis Sling Procedure

• Used when levator function is poor or absent.
• The eyelid is connected to the forehead (frontalis) muscle using a sling made of silicone or autologous fascia.
• The patient uses the forehead muscle to lift the eyelid.

Müller’s Muscle-Conjunctival Resection (MMCR)

• Suitable for mild ptosis with good levator function and response to phenylephrine.
• Involves tightening the Müller’s muscle from inside the eyelid, with no visible skin incision.
• Minimally invasive and often performed under local anesthesia.