PTOSIS

• Abnormal drooping of the upper eyelid is called ptosis
• It is derived from an ancient Greek word, which means “to fall”
• Other related complaints include difficult vision due to the attendant visual field obstruction and prefrontal headaches due to chronic use of the frontalis muscle in an attempt to lift the eyelids
• Normally, upper lid covers about upper one-sixth of the cornea, i.e., about 2 mm. In ptosis, it covers more than 2 mm

Congenital Ptosis

• Poor development of Levator Palpebrae Superioris (LPS) due to idiopathic causes. It is associated with congenital weakness of the Levator Palpebrae Superioris(LPS)

Acquired Ptosis

Depending upon the cause it can be

Neurogenic Ptosis- caused by innervational defects such as:

• Third nerve palsy
• Horner’s syndrome
• Ophthalmoplegic migraine
• Multiple sclerosis

Myogenic Ptosis- It occurs due to acquired disorders of the LPS muscle or the myoneural junction. It may be seen in patients with

• Myasthenia gravis
• Ocular myopathy
• Following trauma to the LPS etc.

Aponeurotic Ptosis- develops due to defects of the levator aponeurosis

Mechanical Ptosis - may result due to excessive weight on the upper lid as seen in patients with lid tumours, multiple chalazion and lid oedema

Characteristic features of congenital Ptosis include:

• Drooping of one or both upper lids
• Lid crease is either diminished or absent
• Lid lag on down gaze
• LPS function may be poor, fair or good depending upon the degree of weakness

Examination

• Exclude Pseudo Ptosis (simulated Ptosis) on Inspection
• Whether then condition is unilateral or bilateral
• The function of orbicularis oculi muscle
• Presence or absence of Eyelid crease
• Associated weakness of any extraocular muscle
• Presence or absence of Bell’s phenomenon (up and out rolling of the eyeball during forceful closure)

Measurement of amount (degree) of ptosis

• Mild ptosis: 2 mm
• Moderate ptosis : 3 mm
• Severe ptosis: 4 mm

Assessment of Levator function

It almost always needs surgical correction

• Tarso-conjunctivo-Mullerectomy

Ayurvedic Management

• Always consider as krichasadya/ asadyaroga

Internal medicines

• Bhadradarvadi kashaya
• Ashtavarga kashaya
• Dhanwanthara Ghrita

Procedures

• Massaging over eyelids and forehead - Dhanwanthara avarthi taila, Ksheerabala taila
• Mukha Abhyanga - Mahamasha taila
• Shasthika Pinda sweda - Local application
• Nasya - Dhanwanthara avarthi , ksheerabala
• Karnapoorana - Bala taila
• Sirodhara -Vatashini taila
• Agnikarma along forehead
• Tarpana – Satahwadi
• Putapaka – Jeevaneeya gana putapaka