Ptosis

What is ptosis (droopy eyelid)?

Ptosis (pronounced to’sis) simply means droopy eyelid. It is one of the most common eyelid problems. The lid may droop slightly, or cover the entire pupil. Ptosis can restrict and even block normal vision. It can be present in children and adults, and is usually treated with surgery.

There is a difference between a droopy eyelid and a baggy eyelid. A droopy eyelid is low. A baggy eyelid (dermatochalasis) has excess skin and fat. The two often occur at the same time in adults.

Ptosis can be inherited, be present at birth, occur later in life, and affect one or both eyelids. Signs and symptoms include: the drooping lid itself, looking up underneath drooping lids (a “chin-up posture”), raising the eyebrows in an attempt to lift the lids, loss of interest in reading due to forehead muscle fatigue, and headaches due to forehead muscle fatigue.

The most common cause of ptosis in adults is the separation of the levator muscle from the eyelid. This may occur due to aging changes, after an injury to the eyelid, after eye surgery such as cataract surgery, or with an eyelid tumor. Less commonly, ptosis in adults may occur with neurological disorders. Additional testing is performed to help diagnose these conditions.

Treatment is usually surgical and involves tightening of the levator (lifting) muscle within the eyelid (external levator advancement). This is performed as a same day surgery with light sedation and local anesthesia. If necessary, a blepharoplasty is performed first. Otherwise, a small incision is made in the natural upper lid skin crease. The levator muscle is tightened using a small, permanent suture. The patient is asked to open her eyes so that lid height, symmetry, and contour can be assessed. It is important for the patient to be alert during this part of the surgery to give the best results. Further adjustments are made, if necessary. The incision is closed using a fine absorbable suture. The patient is seen for a postoperative visit 1 week later. Sometimes, the lid height will need adjusting at that visit, which is comfortably performed in the office under local anesthesia.