Congenital or Acquired Drooping Eyelids
The medical term for a drooping upper eyelid is ptosis (TOE-sis) or blepharoptosis. In this condition, the border of the upper eyelid falls to a lower position than normal. In severe cases, the drooping eyelid can cover all or part of the pupil and interfere with vision, in which case correction may be partly or fully covered by medical insurance.
Ptosis can affect one or both eyes. It may be present at birth (congenital ptosis) or develop gradually over decades. Sometimes it’s an isolated cosmetic issue with no impact on vision or health.
Not infrequently, people develop drooping upper eyelids with age or after eye surgery, including LASIK. Because the drooping often occurs so gradually over the years, patients aren’t always truly aware of how much their vision is being affected. Only a trained oculofacial specialist can perform special tests of your peripheral vision to determine if this is the problem and demonstrate how much improvement could be achieved with a minor corrective procedure.
Some Causes of Ptosis Include:
Congenital ptosis — An infant is born with ptosis due to a developmental problem involving the levator muscle that raises the upper eyelid. In roughly 70% of cases, only one eye is affected. If the drooping eyelid obscures part of the baby’s visual field, surgery must be performed early in life to prevent permanent vision loss.
Aponeurotic ptosis (senile or age-related ptosis) — Aging is the most common cause of ptosis not present at birth. In senile ptosis, the long-term effects of gravity and aging stretch the wide, tendon-like tissue that helps the levator muscle lift the eyelid. Although both eyes are usually affected, drooping may be worse in one eye.
Muscle diseases — Ptosis can be a symptom of an inherited muscle disease called oculopharyngeal muscular dystrophy, which affects eye motion and can cause difficulty swallowing. In younger adults, ptosis can be caused by progressive external ophthalmoplegia, a group of muscle illnesses that cause ptosis in both eyes, eye movement problems, and sometimes throat or heart muscle symptoms.
Local eye problems — In some cases, an eyelid droops because of an infection or tumor of the eyelid, a tumor inside the eye socket, or a blow to the eye.
Symptoms
Doctors assess the severity of eyelid droop by taking precise measurements of the eyelid and eye opening. You can screen for the problem yourself by looking straight ahead in a mirror: a sizable part of your iris should be visible above your pupil, and no part of the pupil itself should ever be covered by the eyelid.
If you have ptosis, the drooping eyelid narrows your eye’s opening, making the affected eye appear smaller than normal. You may also lose the crease that normally lies between your upper eyelid and eyebrow. If ptosis covers your pupil and limits your vision, you may unconsciously compensate by raising your eyebrows, which can cause tension headaches and give your eyes an odd, surprised appearance. You may also tilt your chin up and look down your nose as a way of seeing out from under the drooping lid margin.
Other symptoms include a decreased ability to keep your eyes open, eye strain from the increased effort needed to raise your eyelids, and fatigue, especially when reading. In severe cases, it may be necessary to tilt your head back or lift the eyelid with a finger to see out from under it. You may also notice your eyelids have a tired appearance even when you’re well rested.
Acquired ptosis is usually treated by surgery, typically performed as an outpatient procedure without the need for hospitalization. Local anesthesia numbing the upper eyelid is combined with light sedation, so there’s little to no pain during or after the procedure. The main goals of ptosis surgery are elevating the upper eyelid to restore normal field of vision and achieving symmetry with the opposite upper eyelid.
Final Reminders
Ptosis is usually due to weakness in the muscles or nerves of the eyelid. Effectively treating it requires a special understanding of eyelid anatomy and pathophysiology. Excellent general plastic surgeons who perform tummy tucks and breast augmentations almost never have training in eyelid anatomy and pathophysiology, and shouldn’t be your choice for ptosis correction, which should only be treated by a fully fellowship-trained oculofacial surgeon. Fellowship in the American Society of Oculofacial Plastic and Reconstructive Surgery (ASOPRS) indicates the surgeon has the highest level of specialized training and expertise in this subspecialty.
If you have ptosis, contact Dr. Kass, who is fully trained to treat this problem and has practiced in Tampa Bay for over 30 years.
What to Expect from Eyelid Ptosis Surgery
If you decide to move forward with ptosis surgery at Tampa Bay Cosmetic Surgery Center, you can expect a caring, hands-on approach throughout your treatment. The procedure is typically outpatient, performed under local anesthesia with light sedation to ensure your comfort. Many patients tell us they experience minimal pain during and after surgery.
After surgery, you might notice immediate improvement in your vision and eyelid symmetry, though some swelling and bruising can occur temporarily. Our trusted oculofacial surgeons will provide detailed aftercare instructions to support your healing and answer any questions you have along the way.
Follow-up visits help us monitor your progress and ensure the best possible results. With over 30 years of experience serving patients in , we understand how even subtle changes can impact your appearance and quality of life.
Eyelid Ptosis FAQs
What is eyelid ptosis and how does it affect vision?
Eyelid ptosis is a drooping of the upper eyelid due to muscle or nerve weakness. It can partially or fully cover the pupil, potentially impairing vision and causing eye strain or headaches.
Who is a good candidate for ptosis surgery?
Candidates include individuals with significant eyelid droop affecting vision or appearance, especially if diagnosed by a trained oculofacial surgeon. Both congenital and acquired ptosis cases can benefit from surgery.
How is ptosis surgery performed?
The surgery involves tightening or repairing the levator muscle or related tissue that lifts the eyelid. It’s usually done under local anesthesia with sedation on an outpatient basis.
What are the risks and recovery time after ptosis surgery?
Risks are minimal when performed by experienced surgeons but can include temporary swelling, bruising, or asymmetry. Most patients recover within one to two weeks and resume normal activities shortly after.
Can ptosis recur after surgery?
While surgery aims for long-lasting correction, some patients may experience recurrence due to aging or underlying conditions. Regular follow-up helps manage any concerns promptly.
What causes ptosis besides aging?
Causes include congenital muscle development issues, nerve problems, muscle diseases like myasthenia gravis, and local eye problems such as infection, tumor, or injury.
Why should ptosis be treated by an oculofacial specialist rather than a general plastic surgeon?
Ptosis surgery requires specialized understanding of eyelid anatomy and pathophysiology that general plastic surgeons, who typically focus on procedures like tummy tucks and breast augmentation, don’t have.