Droopy Eyelids (Ptosis)

PtosisPtosis 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.

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.

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).

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.

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. Your surgeon will discuss with you whether the incision and stitches will be on the outside of your upper lid or the inside. 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.

Ptosis surgery is an outpatient procedure. Young children are put under general anesthesia while older children and adults will often receive “twilight” anesthesia. Some surgeons will perform ptosis surgery in an office setting. Your doctor can discuss the options available in your particular situation.

Risks and Complications
Bleeding and infection, which are potential risks with any surgery, are very uncommon. Be sure to tell your surgeon if you are on blood thinners. Minor bruising or swelling is to be expected and will likely go away in one to two weeks. Some patients experience dry eye after surgery. This may make contact lens wear uncomfortable or require over-the-counter tear drops for comfort.

Your surgeon cannot control all the variables that determine the final position of your eyelid. There is ALWAYS a possibility that the lid will be higher or lower than desired or the curve and shape of the lid can be different. Touch up surgery to improve lid position may be necessary. While perfect symmetry between the two eyelids can never be guaranteed, the vast majority of patients see an improvement in their lid position and are happy with their results. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.

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