Drooping or Sagging Eyelids in Infants or Adults

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Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s.  That is to say, the distance between the upper and lower eyelids is smaller than it should be. . This condition may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from limitation of their vision.

What Causes Ptosis?

There are many causes of ptosis, including:

  • Age related weakening of the muscle
  • Weakness present at birth due to poor development of the eyelid muscle
  • Trauma
  • In some cases,neurologic disease

As we age, the major muscle that lifts the eyelid can stretch, weaken and cause the eyelid to fall. This represents the most common cause of a droopy eyelid. Ptosis may also occur in association with long-term use of contact lenses and following routine ocular surgery such as LASIK, cataract, or retinal detachment repair. Children may be born with ptosis or may acquire it due to trauma or neurologic conditions.

Can Ptosis Be Corrected?

Ptosis can be corrected surgically via an outpatient procedure that usually involves tightening the muscles that elevate the eyelid. In severe cases when the muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s). Ptosis repair may sometimes also be performed entirely from the inside of the eyelid, thus avoiding a skin incision.  The goal of surgery is to elevate the eyelid, restoring a full field of vision while achieving symmetry with the opposite eyelid.

What to Expect after Surgery

Recovery after ptosis surgery in adults and children is usually relatively straightforward.  Pain or discomfort tends to be minimal, with the vast majority of patients finding that Tylenol (acetaminophen) alone is typically suitable for maintaining comfort.  While bruising and swelling always occur after eyelid surgery, some patients experience only minimal discoloration, while others have much more prominent signs of having had surgery.  80% of bruising and swelling tends to resolve within the first two weeks after surgery.  Some patients undergo ptosis surgery on a Friday and return to work or school on the following Monday, while others choose to take a week off from their normal routine.