Droopy eyelid (ptosis): causes and care

Ptosis is a condition where the upper eyelid droops, covering part of the eye. This can affect one or both eyes. Eyelids play a crucial role in protecting the eyes, distributing tears, and maintaining corneal moisture. When an eyelid droops, it can obstruct the upper field of vision and create a tired or partially closed appearance. Ptosis can be congenital, meaning present from birth, or acquired, developing later in life.

Congenital ptosis is often caused by poor development of the levator muscle, which is responsible for lifting the eyelid. In these cases, there is a risk of developing amblyopia (lazy eye), astigmatism, or strabismus, and children may tilt their heads or raise their eyebrows to compensate. Acquired ptosis is more common and usually results from aging, as the tendon connecting the levator muscle to the eyelid stretches and weakens. Other causes include eye trauma or previous surgeries, prolonged contact lens wear, and neurological or muscular diseases such as myasthenia gravis, third nerve palsy, Horner's syndrome, or orbital tumors.

The primary symptom of ptosis is a drooping eyelid, which can restrict the field of vision, especially in the upper part. Other symptoms include a feeling of heaviness and fatigue in the eyes, difficulty with activities like reading or watching television, and sometimes forehead wrinkles and headaches due to the effort of raising the eyebrows to open the eye. It is important to note that the external degree of ptosis does not always correlate with the severity of symptoms or functional impairment.

Ptosis is diagnosed by an ophthalmologist, often an oculoplastics specialist. The examination includes an assessment of the medical history, the rate of onset, and duration of the droop. The doctor will evaluate the eyelid position, height, and the function of the eyelid muscles, as well as eye movements and pupils. Sometimes, additional tests such as a visual field test to assess functional impairment, an orthoptic evaluation for strabismus, and in certain cases, blood tests or brain imaging may be performed to rule out neurological or other underlying causes.

The main treatment for ptosis that interferes with vision or causes significant symptoms is surgery. The type of surgery is tailored to the cause of the droop, its severity, and the condition of the eyelid muscles. For mild to moderate ptosis, surgery may involve shortening and strengthening the levator muscle. In cases of severe congenital ptosis, where the levator muscle is very weak, the eyelid can be connected to the forehead muscles, allowing the eyelid to be lifted by raising the eyebrows. The goal of surgery is to improve the visual field and aesthetic appearance.

In infants and children with congenital ptosis, it is especially important to assess the risk of developing amblyopia (lazy eye). Amblyopia is a condition where vision in one eye does not develop properly due to persistent obstruction or interference. If the drooping eyelid covers the visual axis, it can prevent normal visual development. In such cases, earlier surgical intervention may be necessary to prevent irreversible vision damage. Regular follow up with a pediatric ophthalmologist is crucial.

After diagnosis and treatment for ptosis, it is important to continue with medical follow up as advised by your doctor. You should seek urgent medical attention if you experience new and sudden eyelid drooping, especially if accompanied by other symptoms such as double vision, unequal pupil sizes, severe headache, limb weakness, difficulty breathing or swallowing, or other changes in vision or sensation. These symptoms may indicate a more serious underlying medical condition requiring immediate evaluation and treatment.