Eyelid ptosis, or 'droopy lid' usually occurs in adults as a result of dysfunction of the muscle that lifts the lid.
This condition means that the border of either one or both of the upper eyelids ‘droop’ to a lower position than is normal. This can therefore cause unwanted aesthetic problems, giving people the appearance of a tired look. It can also cause visual problems if the eyelid is unable to clear the visual axis and in some severe cases, the droopy eyelid covers the some or all of the eye, therefore affection vision.
Symptoms of Ptosis
The obvious symptom of ptosis is a drooping eyelid, which can affect one or both of the 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, resulting in headaches and neck pain.
The severity of the condition varies from person to person, but typically patients will find it difficult to keep their eyelids open, have eye fatigue especially when reading, have strained eyes and suffer from eyebrow ache as a result of the great effort required to raise their eyelids. For some people, droopy eyelids may not cause medical issues but are simply a cosmetic issue.
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 see better, which can lead to headaches and result in having a strange, surprised appearance.
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
Causes of Ptosis
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 then a person can suffer permanent damage to vision.
The condition can also affect adult patients later on (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, but these are less common.
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.
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.
Droopy Eyelid treatment
The type of treatment offered depends on many factors, but for those suffering with severe ptosis which affects vision and appearance, visiting a plastic surgeon is recommended in order to correct the issue by surgically raising one or both eyelids. This procedure will often involve a hidden incision in the natural skin crease of the upper eyelid. Ptosis surgery can also be performed through the underside of the eyelid, forgoing the need for a skin incision.
The key step in the 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. It is also commonly performed with upper eyelid blepharoplasty to provide an optimal appearance of the upper eyelid and to improve vision.
Other non-surgical treatments are also available and certainly have their role in the treatment of ptosis. These include botulinum toxin 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.
Patients will usually be able to go home after a few hours following the surgery, but children will need to stay in the hospital until the anaesthetic has worn off. Pain medication will be provided and an eye patch should be worn temporarily. It is not safe to drive home from the hospital, so be sure to arrange suitable transportation.
Antibiotic eye drops will be prescribed for several weeks after the operation and should be used correctly to aid 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. Make-up should not be worn on the eye area until the wound is completely finished healing.