Ptosis (Droopy Eyelid)

Drooping or sagging of the upper eyelids is one of the most common conditions treated by an oculoplastic surgeon. Contrary to popular belief droopiness of the upper eyelid is usually a distinct condition from upper lid skin wrinkles. The term “eyelid ptosis” is used to describe the condition where the eyelid margin, the part of the eyelid that eyelashes are connected to, descends to cover part of one’s vision. With ptosis, the eyelid margin or eyelid skin has descended far enough that there is marked obstruction of the colored part of the eye (iris) and if severe the circular center where light enters (pupil).

What are the symptoms of ptosis?

Patients with ptosis may or may not be aware of their condition. Common symptoms are usually related to obstruction of part of their superior visual field. Symptoms include having the eyes frequently feeling tired, a forehead headache from having to constantly elevate the brow to see, and noticing difficulty with activities such as reading or watching TV, especially at night or when tired. Others frequently tell patients with ptosis that they look sleepy or have “bedroom eyes”.

What are the causes of ptosis?

There are many different causes and types of upper eyelid ptosis. Most cases of upper eyelid ptosis relate to impaired function of the muscle responsible for raising the eyelid, which is called the levator palpebrae superioris muscle. Over 90% of all ptosis cases are of the “involutional” or age-related type, where the levator muscle becomes weaker or slips out of position. When upper lid droopiness is present from birth it is called “congenital ptosis” and is usually from a levator muscle that did not form properly during development. In addition to leading to an eyelid that does not elevate as much normal, the muscle may also be less flexible and may not move up and down with full range. Other rare forms of ptosis include “myogenic” and “neurogenic”. Myogenic ptosis is droopiness of the upper eyelids caused by a poorly functioning levator muscle and can be associated with other systemic abnormalities from poor muscle function such as difficulty swallowing. Neurogenic ptosis occurs from nerve damage to the third cranial nerve, commonly occurring after a stroke.

How is ptosis treated?

There are several different treatment options for ptosis repair. Most are surgical and are dependent on the desired amount of eyelid elevation and the type of ptosis being treated. For mild to moderate ptosis where the desired amount of eyelid elevation is 2.5 millimeters or less, minimally invasive “internal ptosis repair” procedures are excellent options that avoid any external scar. These procedures include the Müllers muscle conjunctival resection and the modified Fasanella-Servat ptosis repair. After isolated internal ptosis repair surgery most patients have minimal swelling and bruising and are able to return to work within 1-2 days. The doctors at Eyesthetica have been pioneers in the field of minimally invasive ptosis repair, developing modifications to internal ptosis procedures designed to optimize comfort and post operative aesthetic result. For patients needing greater than 2.5mm of upper eyelid elevation, external approaches with an incision hidden in the eyelid crease offer the ability to raise the eyelid higher. External levator advancement surgery sutures the levator muscle in an advanced position closer to the eyelid margin in patients with greater than 4 mm of eyelid up and down movement. During surgery the patient is sat upright and the eyelid position is adjusted to maximize optimal symmetry and height after surgery. Patients with poor levator function (< 4mm of movement) are usually best served by an upper eyelid blepharoplasty sling surgery or frontalis sling surgery. These surgeries connect the eyelid to the brow and allow eyelid elevation to be controlled by the forehead muscle. Click on the links below to see articles written by the doctors of Eyesthetica on various advanced approaches to eyelid ptosis repair.

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