Eyelid Ptosis (Droopy Eyelid): Causes, Symptoms, and Treatments

Eyelid ptosis (droopy eyelid)

Are you interested in learning about droop eyelids, otherwise known as eyelid ptosis? Truth be told, this condition can cause your upper eyelid to block the vision in one or both of your eyes. Unfortunately, this can create a problem when you try to read, drive, or watch TV.

In this article, Dr. Paul Johnson talks all about eyelid ptosis, including causes, symptoms, and surgical repair.

Why does eyelid ptosis occur?

Eyelid ptosis is frequently associated with extra skin on the upper eyelids – a condition known as dermatochalasis. These conditions are most commonly seen as we get older.

Wear and tear throughout the years leads to a loosening of the support structures of the eyelids. This can then cause your eyelid to droop and your extra skin can actually hang over your upper lid. This creates what looks like an awning that can get in the way of your vision.

Other causes of ptosis include neurologic conditions and bumps, such as styes or skin cancer, that are pressing down on the eyes. Babies can even be born with a type of ptosis known as congenital ptosis.

RELATED: Chalazion (Eyelid Bump): Exactly How To Treat This Annoying Condition

Eyelid ptosis before and after surgery

Diagnosing eyelid ptosis

If you think you might be suffering from ptosis, call to set up an appointment with your local oculoplastic surgeonAt this visit, the surgeon will check your vision, pupils, and the motility of the eyes to determine the cause of your droopy eyelids.

In addition, your surgeon will then take some measurements to determine how severe your droopy eyelids are and the best way to fix them. They will then take photos and have you do a visual field test. This will help demonstrate the amount of vision loss that you are experiencing.

Two common eyelid ptosis surgeries

Truth be told, there are many different procedures used to correct ptosis. With this in mind, I am going to discuss two of the most common surgeries as well as highlight what to expect during surgery and healing times. 

RELATED: Eyelid Ectropion and Entropion: Causes, Symptoms, and Surgical Repair

1) External levator resection and functional blepharoplasty

An external levator resection and functional blepharoplasty is a surgery used to correct droopy eyelids caused by aging. The upper eyelid procedure can also be done as a cosmetic procedure if the droopy eyelids are not blocking vision, but the patient is bothered by the appearance of the eyelids. It is typically performed in the surgery center, but can also be done in the office in select cases. Either way, it is same day surgery. If the surgery is being done in the operating room, it is done under sedation and not general anesthesia.

At a certain point, your surgeon will likely have the anesthesia staff wake you up to make sure the eyelids are even, and then you will go back to sleep. During the surgery, an incision is made in the eyelid crease so that any scar that forms will be hidden in the crease. Next, the extra skin and fat are then removed, and one or more stitches are placed in the muscle of your upper eyelid to raise it. Finally, your skin is stitched closed.

Healing, risks, and final results

There is usually no pain afterward, however, something can be written for pain just in case. You will probably be out of commission for two days, and then it’s back to normal life, except no exercise for a week. As with any surgery, the area will likely bruise and swell. Fortunately, this can be covered by sunglasses or makeup.

Risks of surgery include bleeding and infection. Also, there is a 1 in 10,000 chance that you can lose vision from the surgery (which is extremely rare). Finally, there is about a 10% chance of asymmetry in the post-op period. This can be corrected in the first few weeks after surgery. However, the vast majority of patients who undergo these treatments report greatly improved quality of life after having them done.

RELATED: Eyelid Surgery: What Are the Benefits of a Blepharoplasty?

2) Mullerectomy

The second approach to ptosis repair involves operating from the inside of the eyelid using a procedure called a Mullerectomy. This approach works well for patients who have a neurologic cause of their ptosis – something known as Horner’s syndrome.

At the initial visit, your doctor will place an eye drop called phenylephrine in your eye to see if the eyelid elevates. If it does, you are a good candidate for this type of surgery. Just like the first approach, this procedure can either be done in the surgery center under sedation or in the office under local anesthesia. Either way, the surgery is same-day.

The upper eyelid is flipped over and a clamp is placed on the under surface of the eyelid. A dissolvable stitch is then woven back and forth under the clamp and the extra tissue under the eyelid is removed with fine scissors. This procedure can be combined with excess skin removal from the outside of the eyelid if this needs to be addressed as well.

Healing and risks

Just like with the first procedure, you will probably be out of commission for two days, and then it’s back to normal life, except no exercise for a week. The area will likely bruise and swell, and this can be covered by sunglasses or makeup. Also, the risks are the same.

RELATED: Hordeolum (Stye): Exactly How To Treat This Annoying Eyelid Condition

Conclusion

In the end, eyelid ptosis is something I commonly see in my office and is often a fact of life. Fortunately, surgical outcomes are fantastic (both functionally and cosmetically). If you have any further questions about this eyelid condition, comment below or make an appointment with your local eye care professional today!

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Paul Johnson, MD
Dr. Paul Johnson is a board-certified ophthalmologist with subspecialty training in cosmetic and reconstructive oculoplastic surgery. He performs facial rejuvenation procedures including upper and lower eyelid blepharoplasty (eyelid lift/contouring), brow lifts, Botox injections, soft tissue fillers (Radiesse/Juvederm/Restylane), and chemical peels with meticulous attention to detail. Dr. Johnson is also skilled in reconstructive oculoplastics including ptosis repair, excision, and reconstruction of eyelid skin cancer, orbital decompression surgery, repair of orbital fractures, eye socket reconstruction, management of facial nerve paralysis (Bell’s palsy), blocked tear duct repair (dacryocystorhinostomy), ectropion and entropion repair, management of thyroid eye disease, enucleation and evisceration surgery, and the repair of orbital, eyelid, and tear duct trauma. He attended Johns Hopkins University and Jefferson Medical College. He completed his ophthalmology residency at the prestigious New York Eye & Ear Infirmary, and his oculoplastics fellowship at the top-rated Wills Eye Institute. He has authored multiple publications and has been actively involved in teaching future ophthalmologists at both New York Eye & Ear and Wills Eye Institute.

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