Ptosis or Droopy Eyelid

Overview

Ptosis taken simply, is drooping of the eyelid. There are several causes. Firstly, the excess upper eyelid skin and prolapsed fat associated with aging can mechanically weigh down on the upper eyelid and cause it to droop. This is considered a functional ptosis, as long as the upper eyelid maintains a normal position and functions normally. When it is the actual eyelid that is drooping, whether or not it is associated with excess upper eyelid skin, ptosis becomes the diagnosis. There are several causes of ptosis. The most common cause occurs as a result of the aging process. A specialized muscle is responsible for elevating the eyelid. Over time, it can stretch or detach from its insertions and can allow the upper eyelid to maintain a lower posture when the eyelid is opened. In this instance, the normal upper eyelid crease may appear to have migrated upward. Patients with this problem may display strong contraction of their eyebrow muscles, giving them furrow lines. While most patients don’t realize that they are doing this, they may experience significant fatigue over the course of a day. Patients with this condition may appear chronically tired or angry. Not only can this affect a patient’s appearance, but it can also significantly impair the upper and peripheral visual field. The patient may not notice this, as the central vision, which is used for reading, is not affected. Other causes of ptosis are mechanical because of trauma or previous surgery or tumors of the eyelid depending on their location. A condition call Myasthenia Gravis may present as droopy upper eyelids. Strokes or other neurologic damage to nerves of the face and eyes may also present with or have an associated droopy eyelid. There are several other rare causes of droopy eyelids.

Congenital Ptosis

When a child is born with a droopy eyelid, this is considered congenital ptosis. There are several causes of congenital ptosis and it sometimes can be associated with other problems including misdirected eye muscles. Often times, the eyelid muscle that elevates the eyelid does not develop well. There is a spectrum of severity from very mild to very severe. When significant, the droopy eyelid can block the visual input to the child’s eye and impair the development of that eye. The child may maintain an abnormal head posture in an attempt to see underneath the droopy eyelids. Your child’s pediatric Ophthalmologist will evaluate the functioning of the eyes and eye muscles, and assess whether the associated ptosis is significant and requires correction. If surgical correction is deemed necessary, your child will have a consultation with our Oculoplastic surgeon Dr. Manoj. There are several approaches to the surgical correction of congenital ptosis. Each guided toward severity and cause of the droopy eyelid. It may range from a simple tightening of the upper eyelid muscle if it has good function, or utilizing the brow muscles to elevate the eyelid. There are several ways of accomplishing this goal, from the use of specialized materials and grafting techniques. Your doctors will guide you through this process.