Droopy Eyelids

Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelids, a condition that may affect one or both eyes. Ptosis may be mild (lid partially covers the pupil) or severe (the lid completely covers the pupil). Therefore, concerns with ptosis can range from cosmetic concerns to issues with obstruction of the field of vision.

Lid ptosis needs to be distinguished from dermatochalasis (excess of skin in the upper eyelid). In some patients, both conditions may be present. Dermatochalasis is corrected by doing a procedure called an upper blepharoplasty (removal of excess skin and fat in the upper lid). In contrast, lid ptosis is addressed by correcting the muscles that raise the upper lid.

In children, the most common cause of ptosis is improper development of the levator muscle, the major muscle responsible for elevating the upper eyelid. With adults, ptosis may occur as a result of aging, trauma, or secondary to muscular or neurologic disease.

Ptosis can be caused by congenital or acquired defects in the muscle (or its tendon), which lifts the eyelid. It is also associated with growths, which weigh the eyelid down, or neurological disease. The most common reason Ptosis occurs is simply weakening of the muscle (or its tendon), which occurs with age.

Symptoms of ptosis include difficulty keeping your eyes open, eyestrain, and eyebrow aching 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 in order to see out from under the drooping eyelid(s).

Congenital ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle.

Ptosis surgeries usually involve tightening the levator muscle to elevate the eyelid to the desired position. In severe ptosis, the levator muscle is extremely weak and a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s).

The main goals of ptosis surgery are elevation of the upper eyelid to permit normal visual development and a full field of vision, and symmetry with the opposite upper eyelid. It is important to realize that when operating on an abnormal muscle, completely normal eyelid position and function after surgery may not be possible.

In addition to the removal of the sutures, minor bruising or swelling may be expected and will likely go away in one to two weeks. Bleeding and infection, which are potential risks with any surgery, are very uncommon. As with any medical procedure, there may be other inherent risks that should be discussed with your surgeon.

Your surgery will be performed by Dr. Maleki, a surgeon who is not only board certified in ophthalmology, but also has had extensive training in ophthalmic plastic surgery.