Eye Ptosis 101: Causes, Repair, & Corrective Surgery

Eye ptosis is a condition where the upper eyelid sags or droops. It is most commonly caused by dysfunction of the levator muscle but can also be caused by trauma, heredity, and some medical conditions. Outpatient surgery can often correct ptosis to enhance both vision and physical appearance.

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Overview

Upper eyelid drooping is called eye ptosis (blepharoptosis). It can occur due to genetic predisposition, eye injury or other facial trauma, reduced skin elasticity with age, and the chronic effects of gravity. It can also result from certain medical disorders including Horner syndrome, nerve palsy, eye disease, or an eye tumor.

If only one eyelid droops, then it is called unilateral ptosis. If both upper eyelids sag, then it is called bilateral ptosis. If ptosis is present at birth, which is rare, it is called congenital ptosis. If it develops later in life, it is called acquired ptosis.

Eye ptosis can be mild and not disrupt vision. However, severe ptosis can partially or fully block the eye’s ability to see.

Anyone can develop drooping eyelids, and ptosis affects men and women of all ethnicities almost equally. However, elderly people tend to acquire ptosis more than young. With age, loss of connective tissue proteins like collagen is typical. Stretching and weakening of the levator palpebrae superioris and frontalis muscles that lift the eyelid are also common.

The most common cause of ptosis in children is improper development of the levator muscle that holds the eyelid in its proper raised position. Having drooping eyelids puts a child at greater risks for other eye and vision challenges, including a condition called amblyopia (lazy eye), which causes one eye to see better than the other. A child with ptosis may also develop astigmatism, which causes blurry vision. Misaligned (“crossed”) eyes and double vision may also develop after ptosis.

Eye Ptosis Surgery & Correction

An eye doctor (ophthalmologist) looks at several determining factors when deciding how to best treat eye ptosis. These include:

  • Whether the patient has unilateral or bilateral ptosis
  • The strength of muscles that control the eyelid
  • The eye’s ability to move
  • The height of the eyelid
  • The patient’s age

The primary goal of ptosis treatment is vision correction. In most cases of severe ptosis, surgery is recommended to tighten eyelid muscles that have become stretched or weak.

In most cases, ptosis surgery is performed on an outpatient service at the ophthalmologist’s office. Local anesthesia and oral sedatives are normally used to ensure patient comfort. General anesthesia is not typically used for this procedure.

The American Academy of Ophthalmology recommends that all children be checked regularly for developing ptosis, amblyopia, or other eye/vision problems. If you or your child has an eyelid surgery, it is important for the surgeon to know about any medications, supplements, and herbal medicines you may be using. Many of these substances can interfere with controlling bleeding, blood pressure, heart rate, and other vitals during surgery.

As with all types of surgery, there are risks involved with ptosis treatments. Be sure you understand these risks by discussing them with the doctor during your consultation appointment.

Eye Ptosis Surgery External Approach

The most common ptosis correction procedure is called an external levator advancement. It is used in cases where the upper eyelid crease is high and the levator muscle functions normally, but the aponeurosis has become stretched or disinserted. The aponeurosis is a sheet-like fibrous tissue that acts as a tendon for the levator.

Using an external approach means that the surgeon makes an incision through the outside of the upper eyelid crease (supratarsal crease). This approach allows the doctor easy access to the muscles and tendons that control the eyelid. It also makes it more convenient if excess eyelid skin needs to be removed.

Eye Ptosis Surgery Internal Approach

The surgeon may be able to correct problems of the fibrous connective tissue of the levator aponeurosis, called the tarsus or the Muller muscle, without making an external incision to the supratarsal crease. This is achieved by flipping the eyelid inside-out and then shortening the tissues. However, this procedure is typically only used for minimal ptosis of 2 mm or less.

Eye Ptosis Surgery Frontalis Sling Fixationh

A frontalis muscle sling fixation surgery may be recommended to correct impaired levator function in cases of congenital ptosis. In this procedure, the surgeon attaches the eyelid to the frontalis muscle that controls the movement of the eyebrow. Commonly, the doctor can do this by inserting a silicone rod through the eyelid without making an incision.

Afterward, the patient will have to learn how to control their eyelids using the frontalis muscle instead of the dysfunctional levator muscle. This procedure is effective for correcting severe ptosis but is not typically advised for those with severe dry eye syndrome or corneal sensitivity.

Conclusion

Upper eyelid drooping can partially or fully block the vision and detract from physical attractiveness. Further, a child born with eye ptosis is more likely to develop secondary problems such as a lazy eye, crossed eyes, or double vision.

Ptosis commonly results when the levator muscle that controls the eyelid either fails to develop properly or has become dysfunctional over time. Many people require surgery to restore levator function, bypass the levator by attaching the eyelid to the frontalis muscle or remove excess eyelid skin that interferes with vision.

Ptosis surgeries are quite common and are considered both safe and effective for most patients. However, there are risks for adverse effects associated with any surgical procedure. It is important to understand those risks before committing to having surgery performed. Ask your ophthalmologist about any concerns you have, and have your child’s eyes checked regularly.

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