Droopy Eyelid (Ptosis)
Ptosis (pronounced TOH-sis, with the “p” silent) means droopy eyelid. It comes from the Greek word for falling and is referenced as far back in historical writings as 1743 when Greek medical practitioners described a condition that caused what some called “heavy eyelids.”
Ptosis occurs in both children and adults, and it’s usually is corrected with surgery. Vision typically is slow to develop when babies are born with congenital ptosis, usually the result of poor muscle development. The condition ranges in severity from only a minor drop that’s barely noticeable to completely closing the eyelid. Ptosis can:
- Occur in one or both eyes
- Be present and noticeable from the beginning at birth
- Be genetic
- Not start until later in life
The symptoms of ptosis generally are fairly obvious — droopy eyelids are noticeable on most people even to a layman with no ophthalmologic training. When the condition affects just one eye, it’s even more noticeable. When both eyes are stricken with ptosis, you may think the person is just tired or putting on an air of indifference.
When you suffer from ptosis, your eyes water more than usual and the drooping may lead to impaired vision. Children with ptosis often lean their heads back to see better and can develop an abnormality in their necks or shoulders that comes from accommodating the awkward way in which they have to turn their heads just to take in images. Some children lift their eyebrows to better see from under the drooping lid.
Causes Vary Widely
When adults develop drooping eyelids, it’s sometimes as a result of an incorrect surgical procedure, such as when a tendon in the droopy eyelid accidentally is cut during cataract surgery. The tendons also can be damaged from an accidental injury. Age sometimes plays a role in drooping eyelid development, though very often it’s related to some other underlying health condition such as neurological or muscular disorders. Though rare, ptosis also may be the result of an eye socket tumor.
In children, ptosis almost always is caused by developmental issues that also may show up in eye problems besides the drooping eyelids. When the levator muscles that control the eyelids are not developed properly, many children also experience:
- Other muscular abnormalities
- Difficulty with eye movements
- Neurological disorders
- Tumors in the eyelids or other places
- Refractive errors that lead to more visual problems
Underlying health conditions and other eye diseases also can contribute to droopy eyelids. These might include:
- Swelling taking place in your eye, such as when you have a stye
- Myasthenia gravis — a neuromuscular, autoimmune disease
- Homer syndrome, which refers to a combination of symptoms that usually result from a spinal cord injury, stroke or tumor — Homer syndrome also may present with smaller pupil sizes and decreased sweating on one side of your face
Most often, droopy eyelids are due to nerve damage, weakened muscles or loose skin on the droopy eyelids above your eyes. Your ophthalmologist takes a complete history to find out if you’ve been in any accidents, have been diagnosed with another condition or may have had a stroke.
Your doctor can easily diagnose the condition if it’s occurring in one eye by comparing your two eyes. It’s more difficult to diagnose when both eyes are affected, especially when the drooping is slight. Tests your doctor may employ to give you a definitive diagnosis can include:
- Physical exam
- Visual testing in the field
- A tension test that is used to determine myasthenia gravis
- Slit lamp exam that uses a low-powered microscope to focus a thin beam of high-intensity light — the procedure is commonly performed as a cataract test in your optometrist’s office during routine eye exams
Additionally, before recommending treatment, your doctor takes measurements of your eyelids and sockets to determine the height of your socket, the level of your ptosis and the residual strength of your droopy eyelids. Babies born with ptosis must receive regular eye examinations during their early formative years. Regular ophthalmic eye exams can help your child avoid severe vision loss and amblyopia.
Surgery to repair the sagging eyelids, called a blepharoplasty, is a procedure that’s often performed by plastic surgeons for cosmetic purposes. And a very mild case of ptosis may indeed fall into that category. The cosmetic surgery usually involves removing excess skin on the eyelids and making a small tuck in the muscle that does the lifting. It’s a very common procedure practiced with great success.
Surgery to correct more severe cases of ptosis is more radical and usually requires that the levator muscle be reattached to the droopy eyelid skin and strengthened so that it works properly. While visual improvement usually follows this surgery, very often the lids are not symmetrical and in rare cases, complete eyelid movement never returns.
Treatment for children is imperative and does not include cosmetic considerations. Steps for treating ptosis in children include:
- Eye drops
The type of treatment your ophthalmologist recommends depends on a variety of factors including:
- Whether lazy eye is present
- If both or just one eye is affected
- The height of your child’s eye socket
- Levator muscle strength
- Your child’s age
Typically, when your child’s condition is mild, surgery is not required. When the drooping is too severe, however, surgery usually is noted. And while the same type of strengthening and reattachment are performed in kids as in adults, sometimes the muscles are so weak that the levator muscles must be attached to the eyebrows so the lids can be lifted.
Surgery is almost always successful for restoring vision and eyelid movement, as well as creating a more appealing appearance. And if you or your child doesn’t undergo surgery right away, you may need it in the future. Ptosis may stay at the same level of severity for a lifetime, or it can be progressive over time. It also can come and go, which is all the more reason to maintain those ophthalmologist appointments on a regular basis.
Important Reminder: This information is only intended to provide guidance, not a definitive medical advice. Please consult eye doctor about your specific condition. Only a trained, experienced board certified eye doctor can determine an accurate diagnosis and proper treatment.
Do you have any questions about Droopy Eyelid (Ptosis) treatment or repair? Would like to schedule an appointment with NYC best rated Ophthalmologist or Optometrist, Dr. Saba Khodadadian of Manhattan Eye Specialists, please contact our office for consultation with NYC Eye doctor.
Dr. Saba Khodadadian, Optometrist (NYC Eye Doctor)
New York, NY 10010
(Between Madison Ave & Park Ave)
☎ (212) 533-4821