Ptosis

What is ptosis?

Ptosis of the eyelid is when an upper eyelid droops low over the eye, affecting the visual field. It is known as unilateral ptosis when just one eye is affected, or bilateral ptosis when the condition affects both eyes. Other ptosis symptoms can include difficulty in keeping the eyelids open, eyebrow ache from continuous raising of the eyelids, eyestrain and fatigue. Some patients may also experience cosmetic issues caused by ptosis of the eye.

The condition can affect both adults and children and there are many different ptosis causes. Congenital ptosis is present from birth but acquired ptosis can occur later in life due to trauma, long-term contact lens wearing, following eye operations such as cataract surgery or, less commonly, due to issues with the muscles or nerves.

What are ptosis causes?

Ptosis in children is known as congenital ptosis. This affects a child from birth and is typically caused by issues with development of the levator muscle, which raises the eyelid. This can occur in one or both eyes and can potentially result in a lazy eye, also known as amblyopia. Therefore, ptosis surgery may sometimes be necessary to correct the lid position and prevent further visual issues.

A condition known as Marcus Gunn ‘jaw-winking’ ptosis can also affect small children and cause the droopy eyelid to rise, or wobble, when they open the jaw or chew. This only affects one eyelid and is caused by an abnormal connection of nerves. In some cases, ptosis surgery would be required on both eyelids, to improve symmetry. Your consultant surgeon will be able to advise you further.

Ptosis in adults can affect the eye in later life, and this is known as acquired ptosis. This can be caused by aging changes, contact lens use, swelling of a cyst or stye, or side effects of routine surgeries including LASIK and cataract operations.

Certain rare muscle conditions including myotonic dystrophy and myasthenia can cause the eyelid muscles to weaken. Serious conditions can also cause paralysis of the nerves controlling the eyelid, including nerve palsy (a form of stroke), aneurysm (blood vessel cyst in the brain), cancer and brain tumours. Sudden appearance of ptosis, severe headache, neck pain and double vision are worrying indicators of serious causes and should be seen immediately

In some cases, ptosis surgery would be required on both eyelids, as operating on the affected eyelid can result in drooping of the other eyelid. Your consultant surgeon will be able to advise you further.

What ptosis treatment options are available?

Ptosis correction may not be required for all patients, particularly if the condition is not harming your health or affecting your vision. Your ophthalmologist will be able to assess the condition and recommend the best ptosis treatment for you.

Ptosis surgery is likely to be recommended for children and for individuals where the droopy eyelid is blocking vision, causing a tilted head posture with neck strain or aesthetically a problem.

In adults, this procedure involves administering local anaesthetic and the shortening of the muscles or tendons that are needed to raise the eyelid. These are then reattached to the eyelid with sutures which are applied under the skin and are removed after a week or so following the operation. You will typically be able to go home on the same day as the surgery.

More severe eyelid ptosis may require the eyelid to be “suspended” from the brow. Your surgeon may use an artificial material for this or take tendon-like tissue from your thigh. Brow lift surgery and other cosmetic eye procedures including blepharoplasty are often performed on one or both sides during the same procedure for optimal cosmetic results.

The best options will be discussed with you by the surgeon.

Alternatively, very rarely, a ptosis crutch can provide a nonsurgical treatment option. These are attachments which can be installed on either one side or both sides of glasses frames and hold the eyelid in place to prevent drooping.