Drooping eyelid (ptosis) – causes, symptoms and treatment

Drooping of the upper eyelid, or ptosis, is a condition in which the edge of the eyelid sits lower than it should and covers part of the pupil. Many people treat it as a “tired look” or a natural effect of age, yet ptosis has specific causes, and most of them can be treated effectively with surgery.

Ptosis versus excess eyelid skin

It is worth distinguishing two problems from the start. They often occur together but need different treatment:

• Excess eyelid skin (dermatochalasis) – the eyelid itself is at the correct height, but a hanging fold of skin covers its edge and the lashes. The treatment is upper eyelid blepharoplasty.
• True ptosis – the edge of the eyelid itself droops, because the muscle that lifts the lid (the levator) or its aponeurosis is not working properly. Here skin surgery alone is not enough – ptosis repair is needed.

Telling the two apart is the doctor’s task at the qualification visit: the height of the eyelid opening, the position of the lid edge relative to the pupil and the strength of the levator are measured.

The most common causes

• Age-related (aponeurotic) ptosis – the most common in adults. Over time the levator aponeurosis stretches or detaches from its insertion; the lid droops despite normal muscle strength. Years of contact lens wear and eye rubbing contribute.
• Congenital ptosis – present from birth, due to abnormal development of the levator muscle. In children it needs monitoring, because a covered pupil can lead to amblyopia (a lazy eye).
• Ptosis after procedures – after eye surgery or after botulinum toxin injections around the forehead; the latter is usually temporary and resolves within several weeks.
• Mechanical ptosis – the lid is weighed down by a tumour, cyst, chalazion or swelling.
• Neurological and muscular ptosis – damage to the oculomotor nerve, Horner’s syndrome, myasthenia. These causes need urgent assessment.

When not to wait

Eyelid drooping that appeared suddenly or over a few days, especially with double vision, unequal pupils, headache or muscle weakness that worsens in the evening, requires prompt medical assessment – this is not a situation for routine qualification for surgery.

Symptoms patients report

• a visual field narrowed from above, worse vision when reading and driving,
• reflexively raising the brows and wrinkling the forehead, headaches towards the end of the day,
• tilting the head back to see from under the lid,
• asymmetry of the gaze visible in photos, an impression of tiredness or sleepiness.

What ptosis surgery involves

The technique is chosen according to the cause and the strength of the levator muscle:

• With good levator function (the typical ptosis of mature age) we shorten or reattach the muscle’s aponeurosis. The incision runs in the natural eyelid crease, so the scar is practically invisible. The procedure is performed under local anaesthesia – the patient cooperates with the surgeon, which allows the lid height to be set precisely during the operation itself.
• With poor levator function (some congenital and neurological cases) the eyelid is suspended from the frontalis muscle of the forehead.
• If ptosis is accompanied by excess skin, both problems are addressed in a single procedure.

The procedure is a day case – you go home the same day. Sutures are removed after about a week; swelling and bruising usually settle within 1–2 weeks.

Cost

Ptosis repair of one eye costs PLN 6,000 at OKUMED; the qualification visit is PLN 200. If upper eyelid blepharoplasty is needed at the same time, the scope and price are agreed individually at qualification.

Book a qualification visit with Dr Jarosław Rachoń – Świętojańska 135/2, Gdynia, phone +48 882 650 299 or book online.

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This article is for information only and does not replace a medical consultation.