Introduction
Drooping of eyelids, due to pathological reasons is called ptosis which happens because of trauma, age, or various medical disorders. This condition is called unilateral ptosis when it affects one eye and bilateral ptosis when it affects both eyes. It may come and go or it might be permanent. It can be present at birth, where it’s known as congenital ptosis, or it can be developed later in life, which is known as acquired ptosis.
Depending on the severity of the condition, droopy upper eyelids can block or greatly reduce vision depending on how much it obstructs the pupil. In most cases, the condition will resolve, either naturally or through medical intervention.
Signs & symptoms
One or both upper eyelids sag. In some cases, this can affect the vision.
Dry eyes or watery eyes
Tired look on face
Ache around eyes
Causes
It can be congenital due to defective development of levator muscles or the condition can be acquired.
As a result of a nerve injury or a temporary stye.
Eyelid tumours, cysts, or swelling.
Complication of LASIK or cataract surgery.
Serious conditions like stroke, brain tumour, or cancer.
Neuro-muscular diseases like myasthenia gravis
Botox injections.
Horner’s syndrome.
Pathophysiology
Ptosis is the result of dysfunction of one or both upper eyelid elevator muscles. These elevator muscles are the levator palpebrae superioris and the Mueller muscle.
The levator palpebrae superioris is a striated muscle innervated by the superior division of the oculomotor nerve (cranial nerve III). This muscle is about 40 mm long and originates from the lesser wing of the sphenoid. It continues anteriorly, and at the Whitnall ligament, it travels inferiorly as an aponeurosis. The aponeurosis is 14-20 mm long and inserts into the anterior aspect of the tarsal plate. It also sends attachments to the skin, forming the upper eyelid crease. The levator muscle and aponeurosis is the major elevator of the upper eyelid.
The Mueller muscle, a sympathetically innervated smooth muscle, originates from the undersurface of the levator superioris. Approximately 12 mm long, it inserts superiorly on the tarsal border and elevates the upper eyelid by approximately 2 mm.
Diagnosis
Physical examination
Medical history
Eye examination using a slit lamp
Tensilon test
Treatments
The treatment for droopy eyelid depends on the underlying cause and the severity.
Plastic surgery is the only option in senile and congenital ptosis.
Underlying medical conditions, if any, should be managed for the cure of associated ptosis.
Glasses that can hold the eyelid up, called a ptosis crutch, are another option. This treatment is often most effective when the droopy eyelid is only temporary. Surgery for ptosis includes the tightening of the levator muscle. This will lift the eyelid up into the desired position.
Another alternative is a “sling” operation, in which the forehead muscles are used to elevate the eyelids.
Ptosis crutch – A nonsurgical option that involves adding an attachment to the frames of the glasses. This attachment, or crutch, prevents drooping by holding the eyelid in place.
There are two types of ptosis crutches: adjustable and reinforced. Adjustable crutches are attached to one side of the frames, while reinforced crutches are attached to both sides of the frames.
Prognosis
Eyelid drooping is not a fatal or harmful condition to the general health. However, if vision is affected, treatment is needed.
The long-term outlook will depend on the cause of the droopy eyelid. Most of the time, the condition is just a cosmetic issue.
However droopy eyelids can sometimes be a sign of a serious disease, proper diagnosis is recommended.
Complications
Severe ptosis can cause amblyopia (lazy eye) or astigmatism. It is important to treat at a younger age, if left untreated, it could affect vision development.
Disease & Ayurveda
Vaatahatavarthma
Nidana
Causative factors for eye diseases vitiate mostly Pitta dosha in the body namely,
- Ushnabhitaptasya jalapraveshaath – entering into waterbody or taking bath in cold water after exposure to heat/sun
- Doorekshanaath – Looking at distant objects
- Swapnaviparyaya – Unhealthy & irregular sleeping habits
- Prasaktasamrodhanasokakopa – excess or suppressed weeping & anger
- Klesabhigata – Physical exertion, or trauma
- Atimaithuna – Excess coitus
- Atinishevana of Sukta etc. – taking beverages of acidic nature, horse gram, and black gram
- Vegavinigraha -Voluntary suppression of any natural urges like cough, sneeze, urine, flatulence or faeces
- Swedarajodhoomanishevana – Excess sweating, exposure to dust & smoke
- Chardervighaataad – Suppression of vomiting
- Vamanaatiyoga – Excessive vomiting
- Baashpagrahaat – Suppression of tears
- Sookshmanireekshana – looking at small things
Purvaaroopa
Not specifically mentioned
Samprapti
Causative factors cause vitiation of doshas which travel through siras (circulatory system) and reach eyes causing the disease.
Lakshana
Not able to open eyes because of droopy eyelids
Divisions
Not mentioned
Prognosis
Asaadhya – No treatment/Incurable
Chikithsa
Samana
Sodhana
Commonly used medicines
Thriphala choorna+/-ghee
Dhanwantharam Kashayam
Drakshadi Kashayam
Jeevanthyadi ghrutam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
There is no effective home remedy for ptosis.
But the following preventive measures can be helpful in the protection of eye from diseases:
- Ensure enough intake of anti-oxidants and vitamins
- Control any allergic reactions
- Wear UV-blocking sunglasses while going out
- Keep the eyes and eye wares hygienic
- Avoid scratching or rubbing of eyes
- Use artificial tears to prevent dryness
- To be avoided
Any hard item, tough to bite or chew.
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause a disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase Kapha and cause respiratory problems
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, honey, fruits and vegetables, cow’s ghee.
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain, etc
Behavior:
Protect yourself from too much heat or cold.
Avoid head bath and tongue scraping.
Better to avoid exposure to excessive sunlight, wind, rain, or dust.
Maintain a regular food and sleep schedule.
Avoid stress.
Avoid holding or forcing urges like urine, faeces, cough, sneeze, etc.
Avoid sleeping late night and day sleep.
Yoga
- IN PERSONS WITH SEVERE INFLAMMATORY DISEASES AND EYE DISEASES, EXERCISE IS NOT RECOMMENDED
Yoga can maintain harmony within the body and with the surrounding system.
Nadisudhi pranayama
Suryanamaskara
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://pubmed.ncbi.nlm.nih.gov/12925861/
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
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