Droopy Eyelid

Types of ptosis

Ptosis can manifest in several forms:

Congenital ptosis

Present from birth, this type occurs due to developmental issues with the levator muscle, the muscle responsible for lifting the eyelid.

Acquired ptosis

This form develops later in life and can be attributed to various causes, including age-related weakening of the eyelid muscles, trauma, or underlying medical conditions.

Neurogenic ptosis

Caused by nerve damage, this type is often linked to more severe health concerns like stroke or neurological disorders.

While often considered a cosmetic inconvenience, ptosis can pose significant health risks if left untreated, particularly in severe cases where the drooping eyelid completely covers the pupil. This can lead to amblyopia or “lazy eye” in younger patients and exacerbate pre-existing conditions such as astigmatism due to the eyelid’s altered position.

At The Ezra Clinic, our approach to treating ptosis is guided by a commitment to care and excellence. We offer comprehensive diagnostic assessments to determine the type and severity of ptosis, and our treatment plans are tailored to each patient’s unique needs, ensuring a seamless journey toward recovery and rejuvenation. With our specialists’ profound expertise and the support of cutting-edge technology, we strive to restore not only the function and appearance of your eyelids but also your confidence and quality of life.

What are the symptoms of ptosis?

The most obvious sign of ptosis is the drooping of one or both upper eyelids. This can vary in severity—some may experience a slight sag, while others might find the eyelid significantly lowered, potentially obscuring vision. Here are the most common symptoms that you may notice if you are experiencing ptosis:

Difficulty keeping eyelids open

One of the first signs of ptosis is the effort required to keep the eyelids open, which can become challenging over time.

Eye fatigue and strain

This occurs mainly during activities that require visual focus, such as reading. Constantly raising drooping eyelids can lead to significant eye fatigue and strain.

Eyebrow ache

Many individuals unconsciously raise their eyebrows to compensate for the lowered eyelid, which can lead to discomfort and aching in the eyebrow area.

Altered facial expressions

The effort to lift the eyelids may cause a weary or tired appearance, often accompanied by dryness or excessive tearing of the eyes.

Head and neck strain

Particularly in children with congenital ptosis or severe cases in adults, there may be a noticeable head tilting or chin lifting as the person attempts to see clearly. This can lead to secondary symptoms like neck pain and headaches.

In severe cases of ptosis, individuals might need to tilt their heads back to see properly during everyday conversations, which can affect social interactions and personal comfort. Additionally, if you experience new or worsening symptoms such as migraine headaches or if the drooping eyelids accompany other changes in your health, it is crucial to consult with a specialist.

Recognising these symptoms early and consulting with our specialists can help prevent complications and ensure effective treatment. With The Ezra Clinic, your journey to recovery is in safe, expert hands, ensuring that you can return to seeing the vibrant reflection of your true self once more.

How is ptosis diagnosed?

Initial assessment and physical examination

The diagnostic process usually starts with a physical exam. Our specialists will carefully evaluate the appearance of your eyelids, noting any asymmetry or variation in eyelid height. If both eyelids are affected, the diagnosis may require a more detailed investigation to differentiate it from other possible conditions. We will review your medical history, including any familial incidence of ptosis or muscle diseases, which can be crucial for accurate diagnosis.

Comprehensive eye exam

Following the initial assessment, you will undergo a complete eye exam by our eye care specialists. This includes:

Slit lamp examination

This allows the specialist to view structures at the front of your eye under magnification, which can help assess your eyes’ health and the extent of eyelid droop.

Visual field testing

This is often performed to determine the impact of ptosis on daily activities to understand if droopy eyelids affect your vision field.

Ocular motility test

Assessing the movement of your eyes to ensure that the muscles controlling eye movements are functioning properly.

Advanced diagnostic tests

In cases where the initial tests suggest an underlying condition or if the diagnosis remains uncertain, further tests might include:

Imaging tests

CT or MRI scans may be performed to look for any abnormalities around the eye socket or brain that may be contributing to eyelid drooping.

Blood tests

These might be conducted to check for systemic conditions affecting muscle strength and function, such as myasthenia gravis.

What are the causes of droopy eyelids?

Congenital ptosis

One of the primary causes of ptosis is congenital, meaning it is present from birth. This form is often due to a developmental anomaly in the levator muscle, which is responsible for lifting the eyelid. Congenital ptosis can vary in severity – in some cases, it may significantly obstruct vision, necessitating early surgical intervention to facilitate normal visual development and prevent permanent vision impairment.

Age-related changes

As part of the natural ageing process, the muscles that lift the eyelids can weaken, leading to acquired ptosis. This type of ptosis is shared among the elderly and gradually worsens over time. Age-related ptosis affects appearance and can impair vision if the eyelid begins to obscure the pupil.

Muscle or nerve damage

Ptosis can also result from damage to the muscles or nerves that control eyelid movement. This damage can be due to:

Trauma or injury

Physical injury to the eye or eyelid can disrupt the normal function of the levator muscle.

Surgical complications

Procedures such as cataract surgery or other eye surgeries can inadvertently affect the eyelid’s muscles or nerves.

Neurological conditions

Disorders like third nerve palsy, a stroke that affects the eye’s motor nerves, or other conditions such as myasthenia gravis and myotonic dystrophy can lead to eyelid drooping due to muscle weakness or nerve dysfunction. Horners syndrome is another condition involves a combination of symptoms, including ptosis, caused by disruption to the sympathetic nerves of the face.

Other underlying medical conditions

In addition to specific eye-related issues, ptosis can be a symptom of more systemic health problems. These include:

Marcus Gunn Jaw-Winking Syndrome

An unusual condition where the droopy eyelid raises involuntarily when the jaw moves. This is due to abnormal nerve connections and usually affects only one eyelid and is congenital, meaning that this is something that one is born with.

How to fix a droopy eyelid?

Surgical interventions

Ptosis surgery is the primary method for treating significant ptosis that affects vision and appearance. This procedure involves correcting the position of the drooping eyelid by surgically adjusting the muscles or tendons responsible for lifting it. The surgery targets the levator muscle or its tendon to provide the necessary lift.

Incision techniques

Depending on the specific needs, the surgeon may make a small incision in the upper eyelid’s natural crease or approach the muscle from the underside of the eyelid, avoiding any visible scars.

Combined procedures

Often, ptosis surgery is performed alongside upper eyelid blepharoplasty or a brow lift to achieve optimal cosmetic results and improve vision by reducing the obstruction caused by excess eyelid skin.

Sling operation

A sling operation might be employed in more complex or severe cases where traditional methods may not be suitable. This technique uses the forehead muscles to help elevate the eyelids, providing a mechanical lift that is particularly useful in muscle or nerve impairment cases.

Non-surgical solutions

For patients who are not candidates for surgery or prefer less invasive approaches, non-surgical options are available:

Ptosis props or crutches

An attachment to glasses frames, such as a ptosis crutch, can help hold the eyelid in a lifted position. This device is especially beneficial for those with temporary ptosis or when surgery is not advisable.

Prescription eye drops

Recent advancements include prescription eye drops, such as those containing oxymetazoline hydrochloride. These drops can temporarily elevate the upper eyelid by stimulating the levator muscle, improving eyelid height and vision without surgery.

What are the benefits of surgery for droopy eyelids?

Undergoing surgery for droopy eyelids can significantly enhance your quality of life by:

Improving vision

Correcting the eyelid position can improve your field of vision, especially if the ptosis is severe enough to interfere with regular sight.

Reducing discomfort

Surgery can alleviate associated symptoms such as eye strain and brow ache, often caused by the effort required to raise drooping eyelids.

Enhancing appearance

Surgical correction helps restore symmetry to your facial features and reduces the tired look often associated with droopy eyelids.

What happens during the post-operative recovery period?

After a surgical procedure for ptosis:

Immediate aftercare

Patients can usually return home a few hours after surgery, although children may require a longer observation period. It is important to arrange transportation, as driving is not recommended immediately following the procedure.

Post-operative instructions

You will likely wear an eye patch for 24 hours to reduce swelling and protect the surgical site. Antibiotic eye drops will be prescribed to prevent infection and aid healing.

Follow-up care

Follow-up appointments are crucial to ensure proper healing and to assess the surgical outcome. These visits allow your surgeon to monitor your recovery and make necessary adjustments.

At The Ezra Clinic, our approach to treating ptosis integrates our deep expertise and commitment to providing care that respects your physical and emotional well-being.