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Ptosis (Droopy Eyelid)


 

What is Ptosis? Droopy Eyelid?

Ptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. When the edge of the upper eyelid falls, it may block the upper field of your vision. The ptosis may be mild - in which the lid partially covers the pupil, or severe - in which the lid completely covers the pupil. Ptosis that is present at birth is called congenital ptosis.


What are the causes?

In children, the most common cause is improper development of the levator muscle, the major muscle responsible for elevating the upper eyelid. With adults, it may occur as a result of aging, trauma, or muscular or neurologic disease. As you get older, the tendon that attaches the levator muscle to the eyelid stretches and the eyelid falls, covering part of the eye. It is not uncommon for a patient to develop upper eyelid ptosis after cataract surgery. Ptosis can also be caused by injury to the oculomotor nerve (the nerve that stimulates the levator muscle), or the tendon connecting the levator muscle to the eyelid.


Are there other conditions associated with ptosis?

Children with ptosis may also have amblyopia ("lazy eye"), strabismus (eyes that are not properly aligned or straight), refractive errors, astigmatism, or blurred vision. The condition may be the first sign of myasthenia gravis, a disorder in which the muscles become weak and tire easily;. Ptosis is also present in people with Horner's syndrome, a neurologic condition that affects one side of the face and indicates injury to part of the sympathetic nervous system.


What are the symptoms?

Symptoms of ptosis include difficulty keeping your eyes open, eyestrain, and eyebrow aching from the increased effort needed to raise your eyelids, and fatigue, especially when reading. In severe cases, it may be necessary to tilt your head back or lift the eyelid with a finger in order to see out from under the drooping eyelid(s).


What are the treatments?

Congenital ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. Ptosis surgery usually involves tightening the levator muscle in order to elevate the eyelid to the desired position. In severe ptosis, the levator muscle is extremely weak and a "sling" operation may be performed, enabling the forehead muscles to elevate the eyelid(s). The main goals of ptosis surgery are elevation of the upper eyelid to permit normal visual development and a full field of vision, and symmetry with the opposite upper eyelid. It is important to realize that when operating on an abnormal muscle, completely normal eyelid position and function after surgery may not be possible to achieve. Children with ptosis should be followed closely, both before and after surgery, with eye exams on a regular basis to ensure that their vision is developing properly. Surgery in adults and older children is usually performed' as an outpatient procedure under local anesthesia, and with the patient lightly sedated with oral and/or intravenous medications. Some surgeons prefer to use general anesthesia, especially with younger children, in which case the patient will sleep through the operation.


What are the risks and complications?

In addition to the removal of the sutures, minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.


Copyright: ASOPRS

For questions, contact Swaraj Bose, MD

Meet Dr. Swaraj Bose, MD


Click here for Dr. Bose's CV

Dr. Swaraj Bose is a leading neuro-ophthalmologist, orbital surgeon and strabismus specialist serving patients in Beverly Hills and Culver City area, providing the best care for a broad array of conditions, including complex and specialty issues such as optic neuropathies, lacrimal disorders, eyelid disorders, cranial nerve palsies and ocular diseases. As an accomplished surgeon and research scientist, Dr. Bose works closely with patients to determine the best course of care for optimal outcomes, even in the most complex cases. His advanced skills and expertise combined with a personal, compassionate approach help patients feel confident in the medical and surgical care they receive, and he is committed to taking time with each patient to ensure every question and concern is completely addressed.

After receiving his bachelor of science degree in zoology at Delhi University, Dr. Bose completed his medical degree at All India Institute of Medical Sciences in New Delhi and an internship and residency in general medicine and ophthalmology in India. Upon his arrival in the U.S., he completed an additional internship in internal medicine at the Veterans Administration Hospital and New York University Medical Center, and a residency in ophthalmology at New York University Medical Center. In addition, Dr. Bose has completed fellowships in neuro-ophthalmology, neuroplastics and orbital surgery (Doheny Eye Institute University of Southern California – Los Angeles), neurovascular neuro-ophthalmology (New York University Medical Center and New York Eye & Ear Infirmary), and glaucoma research and visual psychophysics (Scheie Eye Institute, University of Pennsylvania).

In addition to his private practice, Dr. Bose is an associate professor of ophthalmology and neurology at the University of California, Irvine, and an attending physician at Cedars Sinai Medical Center. He has received several awards and accolades, including Best Doctors in America, America’s Top Ophthalmologists, Castle-Connolly’s Best Doctor in Southern California and Physician of Excellence Award (OCMA). In addition, Dr. Bose has held several university research and teaching positions, has served as principal and co-investigator on numerous NIH-funded clinical studies, and has been widely published.

 

"Providing Professional & Compassionate Eye Care"

What we offer

Services

Awards & Associations
  • Best Doctors in Orange County, Orange Coast Magazine
  • Best Doctors in America
  • Fellow, North American Neuro-Ophthalmological Society
  • Achievement Award 2015, American Academy of Opthalmology
  • America's Top Opthalmalogist

For a full list of Dr. Bose's awards and affiliations, view his CV here.

What is a Neuro-Opthalmologist?

Neuro-ophthalmologists take care of visual problems that are related to the nervous system; that is, visual problems that do not come from the eyes themselves. We use almost half of the brain for vision-related activities, including sight and moving the eyes. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles. Neuro-ophthalmologists complete at least 5 years of clinical training after medical school and are usually board certified in neurology, ophthalmology or both.

Although some problems seen by neuro-ophthalmologist are not worrisome, other conditions can worsen and cause permanent visual loss, or become life threatening. Sometimes the problem is confined to the optic nerve or the nervous system and other times it is related to a general medical condition. Neuro-ophthalmologists have unique abilities to evaluate patients from the neurologic, ophthalmologic, and medical standpoints to diagnose and treat a wide variety of problems. Costly medical testing is often avoided by seeing a neuro-ophthalmologist.

Some of the common problems evaluated by neuro-ophthalmologists like Dr. Bose include:

What Does an Orbital Surgeon Do?

In addition to neuro-opthamology, Dr. Bose is also trained in orbital surgery. Orbital surgeons are specially trained to diagnose, treat and perform surgery on the supporting tissues surrounding the eye including eyelids, contents and the bony structure of the eye socket or orbit.

Some common adnexal and orbital diseases treated are:

Dr. Bose also specializes in the assessment and management of eye movement disorders resulting in double vision resulting from paralysis of eye muscles, and scarring of eye muscles from thyroid eye disease by giving prisms and performing surgery if necessary.

 

Modern tests offered at NEOi

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We are pleased to offer the most advanced technological options for our patients at NeuroEyeOrbit Institute!

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What to Expect on Your First Visit

Before your neuro-ophthalmology exam, we ask that you please read the following instructions so you know what to bring and what will happen during the visit. We also recommend that you arrange for transportation home after the exam as your eyesight will be blurry. 

If you have any questions or concerns, please call the office and we'll be happy to assist you. 

Preparing for the Neuro-Ophthalmology Examination:

  1. Request that your treating physicians send all relevant information to us prior to your appointment, including office notes, results of laboratory tests, visual fields, OCTs, retina pictures, and reports of CT and MRI scans.
  2. If you have had a CT or MRI scan performed, arrange to pick up the actual films or a copy in a CD/DVD and bring them with you at your appointment.
  3. You will probably have your pupils dilated during the visit. The eye drops last about 4 hours and will make things look bright and blurry up close. Have someone else drive you to the appointment and bring your sunglasses.
  4. Ladies, in order for the physician to get a good look at your eyelids and to avoid ruining your appearance when the eye drops are administered, do not wear eye makeup.
  5. Bring a complete list of medications with you, including the name and dosage of prescription and over-the-counter medications. 

What happens during the evaluation?

  1. The neuro-ophthalmologic evaluation is one of the most comprehensive examinations you will experience. It may take a few hours to complete. You will be asked to give an account of your current problem and relate your entire medical history, including previous hospitalizations, operations, serious illnesses, medical problems in your family members, and medication allergies.
  2. You will have a complete eye examination. This may include testing of your peripheral vision (visual field test), taking pictures of your eyes and your optic nerves (HRT/OCT), and Ultrasound of your eyes.
  3. You may have a partial or complete neurologic exam to test your strength, sensation, and coordination.
  4. The neuro-ophthalmologist will review the records and scans from previous evaluations, if applicable.
  5. After the examination, the neuro-ophthalmologist will discuss the diagnosis (or possible diagnoses), the need for any additional testing and possible treatment. 
Patient Forms for NeuroEyeOrbit Institute (NEOi)

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Please download the Registration Forms to complete and bring with you to your appointment. 

Click here to access the patient portal.

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Patient Portal

We are pleased to provide patients with secure, 24/7 access to their health records through Dr. Swaraj Bose's Patient Portal. Patients can safely and easily:

  • Request prescription refills
  • Update insurance/demographic information
  • Review financial statements/make secure payments
  • View lab and test results
  • Access relevant health education materials

Patient Portal Login

Major Insurance Providers Accepted

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For questions regarding your specific insurance plan, please contact the office.

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Aetna
Anthem Blue Cross Blue Shield
Anthem Blue Cross of California
Assurant Health
Cedar Sinai Medical Group
Cigna
Health Net
Healthcare Partners
Medicare
Motion Picture Industry Health Plan
Railroad Medicare
Screen Actors Guild
Tricare
UnitedHealthcare
Universal Healthcare
Worker's Compensation

Welcome to NeuroEyeOrbit Institute (NEOi)!

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We are pleased to announce our new location at Cedars Sinai Medical Towers!

We are now seeing patients at Cedars Sinai Medical Towers, East Tower, 8631 West 3rd Street, Suite 200E, Los Angeles, CA 90048.

I am very pleased that you have visited my website and very excited to see you!

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Location

NeuroEyeOrbit Institute
8631 West 3rd Street, Suite 200E
Cedars Sinai Medical Towers

Los Angeles, CA 90048
Phone: 310-469-9080
Fax: 310-469-9085

Office Hours

Get in touch

310-469-9080