Addressing Congenital Ptosis: Solutions for Inability to Blink

Q: Addressing Congenital Ptosis: Solutions for Inability to Blink

Hello： Currently, the available surgical option is the implantation of a "gold plate" in the upper eyelid, which utilizes the strength of the gold plate to achieve a more complete eyelid closure. <br>However, whether this option is suitable for your condition should be discussed

Congenital ptosis with inability to blink?

Hello Doctor, I was born with congenital ptosis in my left eye, which causes it to be almost completely closed, making the eyeball invisible.
As a child, I underwent a levator muscle shortening procedure.
I have become accustomed to the postoperative sequelae of not being able to fully close my left eye when blinking.
However, I have two main issues that have been troubling me for a long time:
1.
The first issue is that I cannot blink my left eye, which makes it appear to others as though I am winking with my right eye.
I have to intentionally use the muscles above my eyebrows to blink my left eye to keep it moist.

2.
The second issue is that when I look down, my left eyelid cannot relax.
This is particularly noticeable when I play the guitar, as I sometimes need to glance at my fingers on the strings.
If someone looks at me during this time, they will notice that, compared to the relaxed state of my right eyelid, my left upper eyelid appears to be pulled up, exposing more of the sclera than my right eye.
I have researched a lot and understand that this is caused by congenital underdevelopment of the eyelid muscles.
I am wondering if, with the advancements in medical technology, there are procedures such as eyelid muscle transplantation or other methods that could help restore at least the normal blinking function of my left eyelid.
Thank you for your response.

Niming, 20~29 year old female. Ask Date: 2018/06/25

Dr. Gao Pilin reply Ophthalmology

Hello: Currently, the available surgical option is the implantation of a "gold plate" in the upper eyelid, which utilizes the strength of the gold plate to achieve a more complete eyelid closure.
However, whether this option is suitable for your condition should be discussed with a specialist in oculoplastic surgery.
The ophthalmology department at Puzi Hospital in Taiwan is available on the following schedule: Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM, and Wednesday from 1:00 PM to 4:30 PM.
Please note that online responses are for reference only, and it is essential to seek medical attention at a healthcare facility if necessary.
We hope to have the opportunity to serve you.
Gao Pilin

Reply Date: 2018/06/25

More Info

Congenital ptosis, particularly when associated with an inability to blink, can be a challenging condition both functionally and aesthetically. Your experience with left eyelid ptosis and the subsequent surgery to shorten the levator muscle is a common approach to address this condition. However, as you've noted, the inability to blink fully and the abnormal appearance of your eyelids during certain activities can be distressing.

1. Inability to Blink: The inability to blink in the affected eye is primarily due to the underdevelopment of the levator muscle, which is responsible for elevating the eyelid. When this muscle is not functioning properly, it can lead to compensatory mechanisms, such as using the forehead muscles to assist in eyelid movement. While this can provide some moisture to the eye, it does not replicate the natural blinking mechanism, which is essential for eye health. The lack of blinking can lead to dryness and discomfort, increasing the risk of corneal damage over time.

2. Appearance During Activities: The cosmetic concern you mentioned, where the left eyelid appears more elevated than the right when looking down, is also a common issue in cases of ptosis. This can be particularly noticeable during activities that require looking down, such as playing the guitar. The asymmetry can draw attention and may affect your self-esteem or how you perceive others view you.

Potential Solutions
Given the advancements in medical technology and surgical techniques, there are several options that could be considered to improve eyelid function and appearance:
1. Surgical Options:
- Levator Muscle Recession or Advancement: If the levator muscle is still functional to some degree, a surgeon may consider a procedure to either advance or recess the muscle to improve eyelid position and function.

- Frontalis Sling Procedure: This involves using a material (often a silicone or fascia) to connect the eyelid to the frontalis muscle (the muscle that raises the forehead). This allows the eyelid to be elevated when the forehead is contracted, which can help with blinking and improve the cosmetic appearance.

- Upper Eyelid Muscle Transfer: In cases where the levator muscle is severely underdeveloped, transferring a muscle from another part of the body (like the temporalis muscle) to the eyelid may be an option. This can restore some degree of eyelid movement and improve the ability to blink.

2. Non-Surgical Options:
- Botulinum Toxin Injections: While not a permanent solution, botulinum toxin can be injected into the muscles around the eye to temporarily improve eyelid position and function. This may help with the appearance of the eyelids during specific activities.

- Moisture Retaining Devices: If dryness is a significant concern, using moisture goggles or punctal plugs can help retain moisture in the eye, reducing the risk of corneal damage.

3. Consultation with Specialists: It is essential to consult with a board-certified oculoplastic surgeon who specializes in eyelid surgery. They can provide a thorough evaluation of your eyelid function and discuss the most appropriate surgical or non-surgical options tailored to your specific needs.

4. Therapeutic Options: In addition to surgical interventions, using lubricating eye drops regularly can help manage dryness and discomfort associated with the inability to blink fully.

Conclusion
While congenital ptosis presents unique challenges, advancements in surgical techniques offer hope for improved eyelid function and appearance. It is crucial to have an open discussion with your healthcare provider about your concerns and the potential risks and benefits of each option. With the right approach, it may be possible to enhance both the functionality and aesthetics of your eyelids, leading to a better quality of life.

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