Ptosis
What is Ptosis?
Ptosis (pronounced “toe-sis”) means “to fall” and refers to drooping of the upper eyelid, covering more of the eyeball than usual. This has to be distinguished from dermatochalasis which is stretching of the eyelid skin resulting in an excessive eyelid skin fold, and from eyebrow ptosis, which is the drooping of the eyebrows (due to the stretching of the forehead skin), which also results in the excessive skin fold in the upper eyelid, causing hooded eyes.
Who is at risk of Ptosis?
- Older age
- Contact lens wear, particular rigid gas permeable (hard) contact lenses
- Frequent eye rubbing
How is Ptosis diagnosed?
The most common cause of upper eyelid ptosis is aponeurotic (or involutional) ptosis. This is due to gravity and ageing, resulting in stretching of the levator muscle in the upper eyelid. The levator muscle is responsible for elevating the eyelid and when it is stretched, the eyelid rests at a lower position.
A detailed examination is required to make sure that there are no serious neurological or muscular causes that needs to be addressed.
Other causes include:
- Muscle weakness – e.g. myasthenia gravis
- Neurological problems – e.g. 3rd cranial nerve palsy
- Congenital ptosis – children born with a droopy eyelid
What are the symptoms of Ptosis?
Eyelid ptosis can make the eyes to appear asymmetrical, or the person to appear tired all the time. The increased effort needed to keep the eyes open can also lead to the sensation of heaviness, or headache. When one upper eyelid is lower than the other, the brain often subconsciously elevates the corresponding eyebrow to help bring up the eyelid, resulting in eyebrow asymmetry.
When eyelid ptosis becomes significant enough that the upper eyelid covers the pupil, it will affect vision as the eyelid obstructs light entering the pupil.
What is the treatment for Ptosis?
There are no exercises that can help elevate the eyelids. The only solution is to undergo eyelid surgery to tighten the levator muscle. Ptosis repair surgery is commonly performed through a thin incision in the natural skin crease of the eyelid, thus resulting in a slight scar that is barely distinguishable from the natural crease. The aim is the elevate the eyelid to an optimal position, making the two sides as symmetrical as possible. There can be an improvement in appearance, heaviness and vision if affected.
What if ptosis is not treated?
As long as serious neurological or muscular causes are excluded, eyelid ptosis itself does not always need to be treated, particularly if it is mild. Surgery can be considered if it is affecting vision or is causing significant concern with the appearance. The degree of ptosis may stay the same for many years, or it may worsen with time.
Eye conditions we treat
Explore the range of eye conditions we can help manage and treat for better vision and eye health.