Droopy Eyelid

What is droopy eyelid?

Droopy Eyelid, known medically as Ptosis, is a condition which means that the border of either one or both of the upper eyelids droop to a lower position than is normal. This can cause unwanted cosmetic problems, giving people the appearance of a tired look. It can also cause visual problems in more severe cases if the droopy eyelid covers some or all of the eye.

What are the symptoms of eyelid Ptosis?

The obvious symptom of ptosis is a drooping eyelid, which can affect one or both eyes. In children with congenital ptosis, the clues to look for are the tilting of their heads back or raising of their eyebrows and chin to lift the eyelids and see clearly. This often results in headaches and neck pain.

The severity of the condition varies from person to person, but typically patients experience the following symptoms:

  • Finding it difficult to keep eyelids open
  • Eye fatigue, especially when reading
  • Strained eyes
  • Eyebrow ache as a result of the great effort required to raise the eyelids.

Why undergo treatment for droopy eyelid?

Ptosis causes the narrowing of the eye opening, when means the eye appears smaller than it actually is. Moreover, if the condition is covering the pupils and therefore causing vision problems, the patient may find themselves subconsciously raising their eyebrows to help them see better, which can lead to headaches and result in having a strange, surprised appearance.

For some people, droopy eyelids may not cause medical issues, but are simply a cosmetic concern.

It is important to seek immediate medical attention if the droopy eyelid:

  • Suddenly develops over a short period of a few hours or days
  • Droopy eyelid is accompanied with double vision, weakness in the facial muscles or arms and legs, difficulty speaking or swallowing, or severe headaches
  • There are also symptoms of eye infection, including pain and redness, fever, bulging eyes, or movement difficulty

What causes droopy eyelid?

Ptosis usually occurs in adults due to a dysfunction of the muscle that lifts the lid. Eyelid ptosis can be hereditary (congenital ptosis), which affects a person from birth and means there is a defect with the levator muscle which raises the eyelids. Congenital ptosis can be mild or severe, but if left untreated, a person can suffer permanent damage to vision.

Some small children may have Marcus Gunn ‘jaw-winking- ptosis, where the drooping eyelid raises when the jaw is opened. This is caused by abnormal nerve connectivity and usually only affects one eyelid.

The condition can also affect adult patients later in life (acquired ptosis), as a result of age, eye trauma, cataract surgery or contact lens wear, which injures the levator muscle as lenses are repeatedly inserted into the eyelid.

There are also a range of neurological conditions that can cause ptosis, such as myasthenia gravis or myotonic dystrophy, but these are less common. Eyelid droopiness may also occur when they are weighed down by swelling or large cysts.

Unfortunately, it is not possible to prevent the occurrence of Ptosis in most cases, and in patients with age-related Ptosis, the droopiness can gradually worsen as time goes on.

How is Ptosis diagnosed?

Many cases of Ptosis are age-related and can easily be diagnosed by comparing your current eyelid appearance with past pictures of yourself to decide whether the droopiness has worsened steadily over time.

However, in other cases of the condition a doctor is required to properly diagnose it and refer a patient for treatment. Your GP will first go over all the symptoms you are experiencing and ask about medical history, including whether Ptosis or other muscle diseases runs in the family. Afterwards, a physical examination will take place to examine the eye area. Where anything abnormal is found, you may need to undergo further diagnostic tests, such as CT or MRI scans.

Where muscle weakness is also found, the doctor may recommend undergoing a blood test to determine whether you have Myasthenia Gravis, which is a rare condition affecting how the muscles respond to nerve messages and can therefore affect the eyelid muscles, amongst others.

How is Ptosis treated?

The type of treatment offered depends on many factors, but for those suffering with severe ptosis which affects vision and appearance, visiting an eye surgeon is recommended. The surgeon will correct the issue by surgically raising one or both eyelids.

Non-surgical treatments are also available and certainly have their role in the treatment of ptosis. These include BoNT and ptosis props, which are attached to glasses. There are also specialised contact lenses which patients can acquire to hold up the eyelid in the correct position.

How is ptosis surgery performed?

Surgery for ptosis usually involves the shortening of the muscles or tendons that raise the eyelid. A hidden incision will be made in the natural skin crease of the upper eyelid. It can also be performed through the underside of the eyelid, forgoing the need for a skin incision.

The key step in a droopy eyelid treatment procedure is the identification of the muscle controlling the lifting of the eyelid, which is then advanced and reattached to the lid. In other, rarer forms of ptosis, a suspension to the brow is performed, whereby the lifting of the brow region is mechanically coupled to the eyelid.

Ptosis surgery is normally carried out under local anaesthetic (general anaesthetic for children) and takes around 45-90 minutes, depending on whether one or both eyelids are being treated. After 1-2 weeks, the sutures can be removed.

It is also commonly performed with upper eyelid blepharoplasty to provide an optimal appearance of the upper eyelid and to improve vision. Brow lift surgery is also often carried out at the same time to achieve a good cosmetic result.

What type of anaesthetic is used in ptosis surgery?

Adults undergoing droopy eyelid surgery will usually be given local anaesthetic and will be awake during the procedure. This allows the surgeon to better judge the lid positioning. Sometimes, local anaesthetic with sedation or general anaesthetic will be used.

For children, ptosis surgery is typically performed under general anaesthetic. Patients should not have anything to eat or drink for at least six hours prior to the surgery.

Is ptosis surgery painful?

No, ptosis surgery is not painful. When the anaesthetic is injected under the eyelid, for a few seconds there will be a minor stinging sensation. During the procedure, you will not be able to feel pain. After surgery, you are likely to feel sore for up to 48 hours, but over-the-counter painkillers can help.

How long is recovery from ptosis surgery?

The recovery period after droopy eyelid treatment is quite minimal, with most patients being able to return to work soon afterwards. Working from home using a laptop can be undertaken the next day and may be preferable for some patients.If your work is particularly manual or involves any sort of heavy lifting, it is advisable to have 1-2 weeks of rest before returning to your job.

After three months, the eyelid should be completely healed.

What are the benefits of ptosis surgery?

Treatment for droopy eyelid can significantly improve your field of vision, enhancing your overall quality of life. It can relieve you of eye strain, brow ache and other symptoms commonly associated with droopy eyelids. Moreover, ptosis surgery enhances your cosmetic appearance, making you appear less tired and improving eye symmetry.

What happens during the post-operative recovery period?

Patients will usually be able to go home a few hours after ptosis surgery, but children will need to stay in the hospital until the anaesthetic has worn off. It is not safe to drive home from the hospital, so be sure to arrange suitable transportation.

Pain medication will be provided, and an eye patch should be worn for about 24 hours to reduce swelling. This can be removed by yourself at home the following day. Antibiotic eye drops will be prescribed for several weeks after the operation and should be used correctly to aid healing. A nurse will show you how to do this before being discharged. Follow up appointments will be made to assess the results of surgery and make sure wounds are healing.

Be sure to keep the wound clean and dry and immediately contact your doctor if there are any signs of infection, such as swelling, redness, discharge, or pain. The upper eyelid may be bruised and sore for 7-10 days and it is advisable to avoid strenuous physical activity for this time.

Swimming, wearing contact lenses and make-up should be avoided until the wound has completely healed.