Ptosis: Drooping Eyelids



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    Age related ptosis of both upper eyelids: Before surgery

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    Age related ptosis of both upper eyelids: After surgery





What is Ptosis?
Ptosis commonly refers to a drooping upper eyelid. This droop may be only slight or it may be enough to cover part or all the eye. It can affect one or both upper eyelids.


What Causes Ptosis?
1. In adults
  • default_titleThe commonest cause is as a result of ageing. The main tendon within the eyelid (levator aponeurosis), which helps lift up the eyelid when looking up, may become stretched resulting in an eyelid tendon which essentially is too long - leading to a drooping eyelid
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Less common causes include:
  • default_titleFollowing an injury or surgery to the eye e.g. glaucoma surgery
  • default_titleFrom long term contact lens wear.
  • default_titleAs a complication of another disease involving the eyelid muscle or its nerve supply, e.g. stroke, myasthenia gravis or diabetes.
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2. In children
Ptosis can be present at birth (congenital ptosis) as a result of abnormal fetal development of the muscle involved in lifting the eyelid. Ptosis in children may also be caused by eye movement abnormalities or diseases affecting the muscle or nerve of the eyelid. Uncommonly, the ptosis may also be associated with abnormal movements of the eyelid itself such as winking whilst chewing, known as “Jaw Winking”.


Symptoms and Signs of Ptosis
  • default_titlePatients may complain about the cosmetic appearance of a drooping eyelid
  • default_titleThe droopy eyelid may obstruct the upper field of vision
  • default_titlePatients may tip their head back or raise their eyebrows in an effort to raise their eyelids, occasionally leading to headache or neck strain
  • default_titleA severe or moderate congenital ptosis, especially if it blocks the line of sight, may hinder normal childhood development of vision, causing a lazy eye (also called amblyopia), which if left untreated, may lead to permanently poorer vision in the affected eye
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How is Ptosis treated?

Treatment may include the following:

Investigations e.g. blood tests. To determine the cause of the ptosis.

Surgery to lift the position of the eyelid.
  • default_titleThe operation is usually done as a day case procedure under local anaesthetic for adults. Surgery performed in young children is usually done under general anaesthesia.
  • default_titleThe type of surgery performed is dependent on the individual characteristics of the patient’s ptosis, however the vast majority of patients do very well with minimally invasive surgery with no visible scarring. This entails making a small incision within the skin crease of the eyelid, finding the main tendon within the eyelid (levator aponeurosis), strengthening the levator aponeurosis tendon using sutures and then finally suturing the skin back together (Levator aponeurosis advancement)
  • default_titleMost ptosis correction operations are performed under local anaesthetic as an outpatient procedure and take 20-30 minutes.
  • default_titleMany patients undergoing surgery for age related ptosis also request simultaneous blepharoplasty (removal of hooded excess skin of the upper eyelids) so that a better cosmetic result can be achieved. Here the excess tissues of the eyelid are removed at the same time as the ptosis operation and on average extends the operation by 30 minutes. There are no additional scars or incisions since both operations are performed via the same incision, using the same anaesthetic.
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Gallery

  • Contact Lens related ptosis

    Left upper eyelid ptosis due to contact lens wear.

  • 2 weeks following surgery

    2 weeks following surgery

  • Contact Lens Related Ptosis

    Contact lens related ptosis

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    Immediately following surgery

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    After surgery. The swelling has disappeared

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    The surgical wound disappears in time

  • Ptosis due to previous trauma

    Ptosis due to previous trauma

  • 1 week following surgery.

    1 week following surgery.

  • Age related ptosis of both upper eyelids

    Age related ptosis of both upper eyelids

  • 2 weeks following surgery

    2 weeks following surgery

  • Contact lens related ptosis

    Contact lens related ptosis

  • 2 weeks following surgery

    2 weeks following surgery

  • Note the tiny wound which often disappears

    Note the tiny wound which often disappears

  • This lady was born with a drooping eyelid

    Congenital ptosis: this young lady was born with a drooping right upper eyelid.

  • 1 week following surgery

    1 week following surgery

  • 4 weeks following surgery. (Mascara patient

    4 weeks following surgery. (Mascara: patient's own)