Our eyelids can droop for a number of reasons. In your experience, you’ve most likely experienced this simply when tired or sleepy. However, in other cases, there can be other underlying reasons for what is known in the medical world as an eyelid ptosis. Some of these causes are simply due to age-related changes to the body while other cases of eyelid ptosis may herald a more serious disease.
What is a Ptosis?
Eyelid ptosis refers to an involuntarily drooping upper eyelid. The eyelid may be only slightly lowered such that it’s barely noticeable, or in some cases can be so lowered that it can block vision from that eye and requires ptosis surgery by an eye specialist experienced in oculoplastic surgery procedures.
While the most obvious sign of ptosis is a drooping upper eyelid, there may be other more subtle signs that point to an issue with a person’s ability to keep their eye open. These signs include adjustments to head posture, such as tilting your head backward or lifting up your chin in order to see through the narrowed opening between your eyelids. A person with a ptosis may also unconsciously raise their eyebrows in an effort to use the forehead muscles to pull their upper eyelids up further.
What is Ptosis Caused By?
An eyelid ptosis can occur in any age group. Children can be born with a ptosis, either on one or both eyes – this is known as a congenital ptosis. Typically, the underlying reason for this is damage or underdevelopment of the muscles responsible for lifting the upper eyelid, or to the nerves that supply these muscles. If the ptosis is severe enough to limit the sight in that eye, your child’s eye specialist will most likely recommend that he or she undergo ptosis surgery reasonably soon so that the normal development of their vision is not unduly impacted. Unnatural head and neck positions from an attempt to see around a ptosis can also cause problems with neck muscle development if not addressed.
In adults, the most common underlying cause of a ptosis is age-related weakening of the levator palpebrae muscle that lifts the top eyelid, or a loosening or detachment of the tendon that helps to anchor this muscle. Ptosis surgery, or a ptosis repair, is able to either reattach the tendon or even shorten the levator muscle so that the upper eyelid can be properly lifted.
There are some cases of ptosis that are due to a more sinister underlying reason. Myasthenia gravis, an autoimmune disease characterised by increasing muscle fatigue and weakness, will often present with gradual worsening of drooping eyelids as the day progresses. This ptosis improves with rest and worsens when the eyelid muscles are exerted, such as when looking upwards for a sustained period of time.
An eyelid ptosis may also be a sign of damage to the nerve that supplies the eyelid levator muscle, such as in the case of Horner’s Syndrome or a 3rd cranial nerve palsy. These conditions are considered serious and may in fact be medical emergencies as they can be associated with the presence of an aneurysm or tumour. Such diseases will typically present with other symptoms in addition to the ptosis, such as unequal pupil size and restricted eye movements causing double vision, and must be managed as per the underlying cause rather than with ptosis surgery.
There have been reports that certain eye operations can induce a ptosis, particularly those that require the use of a tool called a speculum, which is used to keep the eyelids open during the procedure. The theory is that the stretching of the eyelid by the speculum causes damage to the muscle or tendon, resulting in a post-operative ptosis. Post-operative ptosis has been reported after anterior eye operations such as cataract surgery and refractive procedures including LASIK.
If you have been diagnosed with a ptosis, your doctor will first establish that there are no other serious underlying diseases as mentioned above. An ophthalmologist experienced in oculoplastic surgery can do a thorough assessment to determine what is your ptosis caused by and whether it’s suitable for management through ptosis surgery.
A ptosis repair is typically a day procedure performed under local anaesthetic, though your surgeon may also offer you a sedative to ensure the procedure is comfortable for you. There are a couple of techniques the eye specialist may employ during the surgery, depending on the degree of ptosis and the condition of the eyelid muscle or nerve function. Ultimately, the aim of surgery is to raise the eyelid to ensure that it does not block your vision, and to improve the cosmetic appearance, ideally for the height of the eyelids to appear symmetrical.
Immediately after surgery you’ll be given post-operative instructions, such as keeping the operated eye clean and protected from eye rubbing and dirt or dust and avoiding any strenuous activity or contact with unsterile water sources such as swimming pools.
As the operation involves incisions and stitches into the skin and tissues around the eyelids, the final outcome of the surgery may not be apparent for up to a few months after the surgery as the eyelid heals. If required, the eye surgeon can perform a corrective procedure to ensure you’re fully satisfied with the results.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.