Ptosis

Ptosis – an upper eyelid that droops – can give you a headache from the effort of holding it open wider.  But the condition is usually not serious unless the droopy lids interfere with vision.  Ptosis is pronounced TOE-sis.  Blepharoptosis (BLEF-ur-ahp-TOE-sis), is the full name of this condition, comes from the Greek and means “falling lid.”

What Causes Ptosis?

A muscle (the levator) holds the upper eyelid in proper position and moves it up and down.  Anything that affects this muscle will also affect the lid position.  In an adult, most cases of ptosis come on gradually after age 60 or so as part of the normal aging process.  The levator tendon (the fibrous connection between the levator muscle and the lid) stretches, loosening its attachment to the eyelid and causing it to sag.  This age-related ptosis is called “involutional.”

Let common causes include injury, previous eye or orbital surgery, and neurological and muscular problems.  Or the levator muscle or its nerve supply can be involved in a systemic condition, such as diabetes or myasthenia gravis.  Occasionally a drooping lid in an adult has actually been present since birth but was never treated.  {(Check by looking at an old photograph).  Blood tests, x-rays, or other tests are sometimes needed to determine the cause of a ptosis.  If treatment is indicated, the tests can help with planning the best type of treatment. 

Treatment

If the ptosis is not bothering you vision, and you are not concerned with its appearance, nothing needs to be done about it.  Should you decide to have the eyelid repaired surgically; the exact procedure used will depend on the cause.  For example, if a levator tendon has pulled away from the lid, reattaching the tendon can correct the ptosis.  If the muscle is weak, a surgical tuck will tighten the tendon to provide additional lift. 

Surgery is usually performed on an outpatient basis under local anesthetic, and takes less than an hour. After surgery, ice compresses are applied to lessen swelling.  Over-the-counter pain medication, such as aspirin, acetaminophen (Tylenol) or ibuprofen (Advil) can reduce any discomfort you might have.  You will probably want o stay home and rest the first day, and you should avoid strenuous exercise for about one week.  Other than that, there is no need to limit activities.  Patients vary in their response to surgery, but generally the selling is gone within about two weeks. 

What are the Risks of Surgery?

Sometime the operated eyelid does not close well for a few weeks after the surgery.  The partially open eye allows excessive exposure to the air and this can cause the surface of your cornea to become dry, especially during sleep.  You awaken to a burning or scratchy sensation in your eye.  The problem is usually temporary, and lubricating drops and ointments can alleviate the dryness and the discomfort.  If it persists (which is rare and most likely to happen if the ptosis was severe or if the levator muscle is very weak), the lid may need to be lowered surgically.

Less likely is the possibility that the levator muscle will not respond as expected, resulting in lid positions that do the “match” one another.  If that happens, the second operation may be necessary to readjust the alignment.

As with any surgery around the eye, there is a small risk for bleeding, infection, scarring, double vision, or even loss of vision.  Fortunately, these complications are very rare, and if they are discovered quickly, most can be treated successfully. 

Outcome

After the sutures are removed and the swelling has subsided, you may be surprised not to see a scar.  That is because the incision site is usually hidden in a natural eyelid crease or on the underside of the upper lid.  The surgical correction of ptosis is normally uncomplicated and achieves the desired result.  Most patients are delighted with the improved appearance and their unobstructed vision.