A drooping eyelid is called ptosis or blepharoptosis. In ptosis, the upper eyelid falls to a position that is lower than normal to the extent it partially covers the pupil. It can affect one or both eyes and affects all races as well as men and women equally. Ptosis may be present at birth or may be acquired later in life. As we age, the muscles that hold up our eyelids weaken or loosen and can cause our lids to droop. This results in a tired, sleepy appearance and reduces peripheral vision. Some individuals experience brow or forehead aches and fatigue at the end of the day from constantly raising their brows to see.
Ptosis is seen in both adults and children. It may also be caused by an injury, birth defect or neurological disorder. Surgical repair helps improve vision and provides a more vibrant appearance overall. There are various surgical approaches to address ptosis including an external approach, an internal approach, and even the use of suspension slings in very severe cases. Ptosis surgery is very delicate and requires a thorough understanding of the anatomy and function of the muscle. A thorough discussion and consultation with Dr. Phelps will allow you to answer any questions related to the procedure.
Am I a good candidate for Ptosis surgery?
Dr. Phelps will diagnose ptosis by carefully examining the eyelids. He will take detailed measurements of the height of the eyelids and will assess the strength of the eyelid muscles. If someone is a good candidate, surgery can be an effective treatment for ptosis in both children and adults, improving vision as well as cosmetic appearance. It is very important that children with ptosis have regular ophthalmic examinations early in life to monitor their vision and prevent severe vision loss from untreated amblyopia, also known as ‘lazy eye’.
Congenital Ptosis Treatment
In most cases of congenital ptosis, the problem is isolated and does not affect the vision. In other cases, the treatment for childhood ptosis is surgery. If amblyopia is present, treatment with patching, eyeglasses, or eye drops may be necessary. In determining whether or not surgery is necessary and which procedure is the most appropriate, an ophthalmologist should consider these important factors:
- The child’s age
- Whether one or both eyelids are involved
- The eyelid height
- The eyelid’s lifting and closing muscle strength
- The eye’s movements
During ptosis surgery, eyelid-lifting muscle (levator) is tightened. In severe ptosis cases, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so that the forehead muscles can do the lifting.
Mild or moderate ptosis usually does not require surgery early in life. Children with ptosis, whether they have had surgery or not, should be examined regularly by an ophthalmologist for amblyopia, refractive disorders and associated conditions. Even after surgery, focusing problems can develop as the eyes grow and change shape. Any ptosis that develops over a period of days or weeks can signal a serious medical problem and needs further neurologic and physical evaluation.
Adult Ptosis Treatment
Dr. Phelps can determine the cause of the ptosis and plan the best treatment. If treatment is necessary, it is usually surgical. Sometimes a small tuck in the lifting muscle and removal of excess eyelid skin (called blepharoplasty) can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.
What are the risks of Ptosis surgery?
The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications are not common. Immediately after surgery, you may find it difficult to completely close your eye, but this is only temporary. Lubricating eye drops and ointment can be helpful during this period.
Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation may be required.