Droopy Eyelids (Congenital Ptosis, Acquired Blepharoptosis)
Blepharoptosis, commonly known as ptosis (droopy eyelids), is the term used to describe the drooping of one or both eyelids. Ptosis can be present at birth (congenital ptosis) or it can develop over time (acquired ptosis) due to aging, trauma, or various medical conditions. Most patients develop ptosis over time when the eyelid muscle attachments become weakened. The condition can be intermittent, constant, or worsen over time.
While a drooping eyelid is usually not a serious condition, in severe cases it can cause vision problems. Children with ptosis can suffer permanent vision loss if the condition goes untreated. Ptosis commonly occurs with dermatochalasis and may require the treatment of both conditions to eliminate the drooping eyelid. A proper examination by an ophthalmic plastic surgeon can determine the underlying cause.
Other Conditions to Consider When Evaluating a Drooping Eyelid
Dermatochalasis, often referred to as “baggy eyes”, is excess skin and/or fat on the upper or lower eyelid. If there is enough excess skin and/or fat on the upper eyelid, eyelid drooping can occur. Patients may experience varying degrees of this condition. A mild to moderate case of dermatochalasis can result in an appearance that is sad or tired looking. More severe cases can result in changes in vision and may require surgical correction.
Brow ptosis, or a drooping of the eyebrow, is also a consideration when evaluating drooping eyelids. When the brow descends to a lower position, a drooping eyelid can result. Brow ptosis condition can coexist with both dermatochalasis and ptosis.
Causes of Ptosis
Eyelid drooping can develop at any time, regardless of age. It is often seen in older people due to the aging process, but can also signal an underlying medical condition, some of which may be neurologic, mechanical or muscular in nature. Possible causes include:
• Brain aneurysm
• Brain tumor
• Eyelid tumor
• Horner’s syndrome
• Myasthenia gravis
• Myotonic dystrophy
• Nerve injury
• Sty / Stye
A physical examination and tests are necessary to determine if any of these conditions are the cause of the eyelid droop.
Diagnosing Eyelid Drooping
After completing a medical history and physical exam, your doctor may want to run tests, such as the slit-lamp test, Tensilon test, and visual field test, to find the cause of the eyelid drooping.
The slit-lamp uses a low-power microscope and a high-intensity light source that can be focused to provide a thin beam. This test allows your doctor to examine the eyes, especially the eyelids, cornea, conjunctiva, sclera, and iris. Drops may be placed in the eyes to dilate the pupils, which may cause some discomfort. The slit-lamp examination is then repeated using another small lens held close to the eye, so the back of the eye can be examined.
The drug Tensilon is injected into your veins. The doctor will ask the patient to perform eye movements to access if the drug improves muscle strength. This test will help determine whether the eyelid drooping is due to neuromuscular issues from an autoimmune process.
Visual Field Test
The visual field refers to the total area in which objects can be seen in the side (peripheral) vision while you focus your eyes on a central point. This eye exam uncovers any vision deficiencies in your visual field and helps determine the cause. Abnormal results may be due to diseases or central nervous system disorders, such as tumors that damage or press on (compress) the parts of the brain that deal with vision.
Treatment for Ptosis (Droopy Eyelids)
Treatment options for drooping eyelids vary. If the drooping is due to aging or is not considered harmful to one’s health and vision, there may be no treatment recommendation. Surgery is usually recommended if the drooping causes an obstruction to one’s vision or if it is found to be due to an underlying medical issue. Cosmetic surgery is also an option for patients who wish to correct drooping eyelids when the condition is not found to be harmful.
Types of Surgical Treatment for Ptosis (Droopy Eyelids) and Dermatochalasis
There are different surgical techniques available to address the different types of ptosis. In general, the surgery involves tightening the muscle of the upper eyelid. In severe ptosis, a sling or suspension procedure may be required to allow the eyebrow (frontalis) muscle to help open the eyelid. The surgery is performed on an outpatient basis, meaning that the patient can go home the same day of the surgery and not stay overnight in the hospital. Infants and children require general anesthesia during the surgery. Adults may have “twilight sleep” using IV sedation. A thorough evaluation of the ptosis is required to determine its cause as well as the treatment options.
Blepharoplasty is a surgical procedure that corrects eyelid defects and disfigurations. Excess tissue is removed or repositioned while muscles and tendons in the eye region are reinforced, if necessary. This procedure can fix functional and cosmetic problems from the eyebrow region to the upper portion of the cheek. Normally, this type of surgery takes about 1-2 hours to complete. There are three major types of eyelid blepharoplasty surgery, lower eyelid blepharoplasty, double eyelid blepharoplasty, and upper eyelid blepharoplasty.
Lower Eyelid Blepharoplasty
Lower eyelid blepharoplasty is performed on the lower eyelid to remove excess skin and fat, reduce wrinkles, and improve the appearance of the skin around the eyes. Using a transconjuctival approach, incisions are inside the eyelid to allow access to eyelid fat without visible incisions. eyelid tightening may also be performed with this surgery to improve the skin’s appearance and correct sagging or drooping eyelid.
Double Eyelid Blepharoplasty
Double eyelid blepharoplasty, also known as “Asian blepharoplasty”, creates a double-lidded appearance by adding a crease in the upper eyelid where, naturally, one does not exist. Because there are many variations in the upper eyelids of East Asians, several methods can be used to create the double eyelid. Full-incision, partial incision, and no incision methods each have advantages depending on the patient’s anatomy and desired results.
Upper Eyelid Blepharoplasty
An upper eyelid blepharoplasty removes skin and fat from the upper eyelid through incisions and creates an eyelid crease by bringing the skin together. When the upper eyelid loses elasticity, the drooping that results can lead to vision loss and impairment, negatively affect daily activities. By removing the excess skin and fat, vision can be improved while improving the aesthetics of the eye.
Recovery from Ptosis (Droopy Eyelid) Surgery
Blepharoplasty recovery is usually short with the worst bruising and swelling occurring the day after surgery. Swelling can be reduced by using cold compresses and engaging in light activities, such as walking. while the stitches self-absorb after a week. One can resume normal activities after 7-10 days and most of the swelling resolves in two weeks. Full results become visible after several months.
Possible Risks from Ptosis (Droopy Eyelid) Surgery
Because blepharoplasty is a surgical procedure, potential risks are involved. When discussing the details of the procedure with one’s ophthalmic plastic surgeon, it is important to ask about the possibility of complications.
Like any other medical or surgical process, blepharoplasty has several potential complications. These complication possibilities include:
• Additional eyelid disorders, such as ectropion (outward turning of the eyelid) or entropion (inward turning of the eyelid)
• Difficulty blinking or closing the eyes
• Dry eyes
• Numbness or pain
• Revisional eyelid surgery
• Blurring of vision or lid lag
• Undesirable scars
• Vision loss
Will Insurance Cover Ptosis (Droopy Eyelid) Surgery?
Insurance will cover the surgery if it is affecting vision, but strict visual field criteria have to be met. Most insurances will not cover more than one surgical procedure at the same time. Some patients choose to prioritize the surgeries, according to which issue bothers them most, and repair the issues on separate occasions. Patients also have the option to pay out-of-pocket in order to have the surgeries at the same time.
If you would like to arrange a pediatric or adult eye consultation with an ophthalmologist at ABC Eyes, please submit an online appointment request or call one of our offices: