Eyelid ptosis

What is eyelid ptosis?

Ptosis is a drooping of the upper eyelid. The eyelid may droop only slightly, or it may cover the pupil, and one or both eyelids may be affected. Ptosis that is present at birth is called congenital ptosis. If the ptosis in one eyelid is severe, the child’s vision may not develop properly, which can lead to amblyopia (also called lazy eye, a condition in which the brain uses the images from the “good” eye only). Ptosis that develops later in life is called adult or acquired ptosis.

How does it occur?

Congenital ptosis occurs when the levator muscle – the muscle that lifts the eyelid – is poorly developed.

Acquired (adult) ptosis occurs when there is an abnormality in:

• the levator muscle
• the levator muscle tendon
• the nerve supply to the levator muscle

These abnormalities can be caused by:

• ageing
• muscle or nerve disorders
• tumours or aneurysms
• injury
• diseases, such as diabetes, that affect the nerves and muscles

If ptosis appears suddenly, the cause may be a brain aneurysm. This is a medical emergency.

What are the symptoms?

A drooping eyelid is the main symptom of ptosis. People with ptosis may tilt their head backwards or raise their eyebrows to lift the eyelid. Adults may notice a loss of vision, especially in the upper part of their visual field. After many years of holding the head in abnormal positions, deformities of the head or neck can develop.

How long will the results last?

Congenital ptosis will not improve without surgery, but timely correction will help the child develop normal vision in both eyes.
Some cases of acquired ptosis caused by nerve problems improve without treatment, and ptosis due to muscle disease may improve when the disease is treated with the appropriate medication. Often, however, the ptosis persists until the appropriate surgery is performed.

How is the diagnosis made?

The ophthalmic surgeon will examine you thoroughly and may order blood tests and brain imaging to determine the cause and the best treatment plan.

How is it treated?

Treatment for congenital ptosis is usually surgery to attach the levator muscle to the muscles of the brow. All children with ptosis, whether they have had surgery or not, should have regular eye examinations to check for any problems that may arise.

Treatment for acquired ptosis depends on its cause. If the ptosis is the result of a muscle or nerve disease, the doctor will treat that disease first. If the cause is a tumour, it can sometimes be removed. If the ptosis is simply due to the normal ageing process, the oculoplastic surgeon may recommend surgery to shorten the levator muscle or remove the excess skin that weighs the eyelid down.