Ptosis is also called “drooping eyelid.” It is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control those muscles, or looseness of the skin of the upper eyelids.
Ptosis of the eyelid refers to a loss of function of the main lefting muscle / tendon of the eyelid, and is different from simply having excess skin hanging over the eyelid. Ptosis is usually due to one of two processes: the tendon that connects the muscle to the substance of the eyelid becomes thinned, weakened, or detached; or the muscle that lifts the eyelid degenerates or is otherwise abnormally replaced with fat or fibrosis. Surgery is generally divided into three groups:
- External incision eyelid surgery (levator advancement, levator resection)
- Internal incision eyelid surgery (conjunctivomullerectomy)
- Eyelid and forehead surgery, for severe cases (frontalis suspension)
Drooping eyelid can be caused by the normal aging process, a congenital abnormality (present before birth), or the result of an injury or disease. Risk factors include aging, diabetes, stroke, Horner syndrome, myasthenia gravis, and a brain tumor or other cancer, which can affect nerve or muscle reactions.
- Drooping of one or both eyelids
- Increased tearing
- If ptosis is severe, interference with vision.
Exams and Tests
- A physical examination to determine the cause
- Special tests may be done to evaluate suspected causes
- In cases where ptosis interferes with vision, visual field testing can be performed by your ophthalmologist to determine whether you need surgical correction.
If an underlying disease is found, the treatment will be specific to that disease. Most cases of ptosis are associated with aging and there is no disease involved. Surgery can be done to improve the appearance of the eyelids in milder cases if the patient wants it. In more severe cases, surgery may be necessary to correct interference with vision. In children with ptosis, surgery may be necessary to prevent amblyopia.
The expected outcome depends on the cause of the ptosis. Surgery is usually very successful in restoring appearance and function.
If a drooping eyelid is left uncorrected in a child, it can lead to lazy eye.
When to Contact a Medical Professional
Drooping eyelids in children require prompt evaluation by an ophthalmologist. New or rapidly changing ptosis in adults requires prompt evaluation by an ophthalmologist.