37.2.1 Eyelid Crutches

An eyelid crutch is a bar that is placed along the inside of an eyeglasses frame to support the eyelid (Fig. 37.1). These devices are made of metal wire and custom-designed to accommodate the shape and contour of the eye and eyelid. The crutch is positioned at or just above the eyelid crease, applying backward and upward pressure against the upper eyelid which tucks the eyelid and raises the margin above the pupil. There are two types of eyelid crutches: adjustable for mild amounts of ptosis, and reinforced for moderate to severe ptosis. ¹ An adjustable crutch attaches to the lens frame typically on the nasal side of the frame, and can be adjusted based on the degree of ptosis. This type of crutch is ideal in patients suffering from conditions in which the ptosis fluctuates. This type of crutch often migrates and needs to be readjusted due to weakening of the metal from its pivot point on the spectacle. ¹ Reinforced crutches are secured at both ends to the lens frame. Thus, they have the disadvantage of not being adjustable, but the advantage of not migrating.

Eyelid crutches are ideal for patients who are poor surgical candidates or those with temporary or fluctuating symptoms. Limitations include discomfort, especially if improperly fitted, restricted blink, the requisite cleaning regimen, and risk of damage to the globe in an accident. Glasses fitted with eyelid crutches should not be used for extended duration as restricted blink may lead to drying of the eye.

37.2.2 Eyelid Taping

Similar to the eyelid crutch, eyelid taping can be used as a temporary measure to elevate the eyelid (Fig. 37.2). Various types of disposable, adhesive tapes may be used, and the method is safe, inexpensive, and easy to use. Though not routinely used, one study has demonstrated efficacy of octyl-2-cyanoacrylate liquid bandage for severe ptosis. ² The disadvantage of eyelid taping is that the tape must be applied daily, and efficacy is largely user-dependent. In patients with a poor Bell’s phenomenon, eyelid taping should be used for small time periods to ensure corneal protection.

37.2.3 Haptic Contact Lens

Ptosis crutches and eyelid taping may not elevate the lid satisfactorily and can cause severe dry eye symptoms. These aids restrict the natural blink reflex, and as such they should be avoided in cases of dry eye, exposure keratopathy, and in patients at risk for exposure keratopathy. In such cases, a “prop” or haptic contact lens is an option. A haptic contact lens is a scleral contact lens equipped with a shelf on which the margin of the upper eyelid rests (Fig. 37.3). As an alternative, a vaulted PROSE lens may be used (Fig. 37.4). The lens traps tears to protect the cornea, creating a prosthetic ocular surface environment. This option is particularly useful in patients with myotonic dystrophy and other types of ptosis accompanied by poor orbicularis function. ³ The major benefit of haptic contact lens use is superior protection of the corneal surface. Limitations are the potential for discomfort and the need for meticulous lens hygiene.