Ptosis Causes - What Causes Droopy Eyelids?

The eye area is well known for being the first to change as a result of ageing. Your eyelid skin may weaken over time and begin to relax, sag and appear droopy. This is completely normal and is usually caused by a loss of two very important proteins, elastin and collagen.

In some cases, however, one eyelid can be more droopy than the other, or both eyelids to fall significantly downward. This condition, which is called ptosis, can not only affect the aesthetic appearance of the face but can also lead to vision problems. One of the most common causes of this cosmetic issue is ageing, but sometimes such droopiness might be related to an underlying medical condition.

Here, we will take a closer look at droopy eyelids, what may cause them, and how plastic surgery can help you deal with the problem.

What is a drooping eyelid (Ptosis)?

Ptosis, commonly known as a droopy eyelid, is a condition characterized by an abnormally low position of the upper eyelid. It normally covers about 1mm of the cornea. However, in some cases, it may have fallen so far as to cover the pupil. The condition may affect one or both eyelids.

Ptosis isn't just an aesthetic issue; it can also reduce or completely block normal vision. The good news is that plastic surgery can effectively improve both your vision and the appearance of your eyes.

Sometimes people confuse this with double eyelid surgery - while they may seem similar, they are quite different procedures.

What might be the reason behind droopy eyelids?

There are a number of reasons that can lead to the appearance of droopy upper eyelids. There are also different types of droopiness that can occur. The condition can be present at birth (congenital ptosis) or you may develop it later in life (acquired ptosis).

Causes of congenital ptosis

Some children are born with drooping eyelids, and this is called congenital ptosis or droopiness. In most cases, it is caused by improper development of the muscle responsible for lifting the eyelids (levator muscle).

Children who have eyelid drooping, are also more likely to develop amblyopia. This is a condition where the vision of the affected eye is reduced. It is more commonly known as lazy eye.

The congenital droopy eyelid may also be related to family history and rarely to a medical issue. However, this condition requires a thorough examination by an eye specialist or a doctor experienced in pediatric ophthalmology.

Causes of acquired ptosis

Acquired eyelid drooping, or ptosis is one that you can get later in life. It might be due to ageing, eye injury or as a result of a medical problem. Here is more about the possible causes of eyelid drooping in adults.

• Ageing. The most common cause of eyelid droopiness in adults is just the natural ageing process. The older you get, the weaker and more stretched your eyelid muscles and skin becomes.
• Eye trauma. Some eye injuries may damage the nerves that are responsible for lifting the eyelid which in turn will cause a droopy eyelid. You may also develop ptosis due to excessive rubbing of your eyes.
• Eye surgery. Sometimes, upper eyelid ptosis occurs as a side effect of certain eye surgery. For instance, cataract surgery, in some cases, may lead to stretching of the eyelid muscle and consequently drooping eyelid.
• Medical disease. Certain health conditions can cause nerve damage to eyelid muscles and make the upper eyelid droop.

Many times, upper eyelids sag and droop just due to ageing. However, you should always consult a doctor if you are experiencing eyelid ptosis. This is especially important if the condition appears suddenly and is accompanied by other complications such as pain or double vision.

What are the symptoms of eyelid ptosis?

Symptoms of drooping eyelids may vary depending on the severity of the condition. Here are some of the signs that may indicate you have ptosis.

• Sagging of the upper eyelids. This is the main symptom of the condition. When it is caused by ageing it is normally seen in both eyes, while ptosis caused by eye injury or disease is more likely to affect one eye.
• Eye strain. Eyelid drooping may affect the ability to see clearly, which may result in eye strain. It may also cause other symptoms such as blurry vision or double vision.
• Tired and sleepy appearance. When your vision is reduced, your eyes strain more and this gives you a tired and sleepy look.
• Head and neck issues. This can happen when the lid droops to such a degree that the person needs to tilt the head back or raise the eyebrows to see under the eyelid. This is commonly seen in children with ptosis.

The most obvious sign of eyelid ptosis is the actual droopiness of one or both eyes. In some cases, it might be mild and barely noticeable, but in other cases, it can be severe and affect your vision. It is also possible for ptosis to occur alone or in conjunction with other complications. Whatever the case, you should see a doctor to make sure the eyelid drooping is not related to any health problem.

How do you treat drooping eyelids?

One of the most effective treatment options for ptosis is eyelid lift surgery or ptosis surgery. The procedure can help you tighten the eyelid muscles and lift the skin so that your eyes look more open. The surgery is commonly done simply for aesthetic reasons. However, if you have severe eyelid drooping which interferes with your ability to see properly, then your doctor may recommend surgery to help you achieve better vision.

When a certain medical condition is behind your eyelid ptosis, then your healthcare provider will first treat it. This should prevent your eyelids from further drooping. However, such treatment will not reverse the existing eyelid drooping that you have already developed, so you may want to get plastic surgery to correct it.

How is ptosis in children treated?

Most doctors recommend surgery for treating ptosis in children. This is either to tighten the levator muscle or to attach the eyelid skin to other muscles that can help lift the eyelid. The goal is to improve vision. However, the ophthalmologist will consider several factors when deciding the best way to treat ptosis in children. These include:

• the age of the child;
• whether one or both eyelids are affected;
• the height of the eyelids;
• the strength of the eyelid muscle;
• eye movements.

If the child has amblyopia or lazy eye, it should also be treated. This condition can be improved by wearing an eye patch, special glasses, or using certain eye drops to strengthen the weaker eye.

How does ptosis surgery work?

Ptosis surgery raises the upper eyelids in a higher position. The surgery can give you more symmetrical-looking eyes which are higher, more open and less sleepy. It can also improve your vision.

There are two techniques used for ptosis correction. The first one is where the surgeon tightens the eyelid muscle and lifts the skin by making an incision on the external part of the lid. Extra skin can also be removed if needed. This technique is normally used for patients with more severe ptosis.

The second surgical method does not involve incisions. The muscle tightening is done from inside, underneath the upper lid. This is a less invasive approach and usually provides more natural results. However, it is more likely to treat mild ptosis and is not suitable for severe cases.

In most cases, surgeons use a local anaesthetic to correct the eyelids. In addition, it is typically performed as a standard outpatient procedure, meaning you do not need to stay at the clinic overnight. Following the surgery, your doctor will advise you on any necessary aftercare and when you should return for a check-up.

What doctor should you see if you have ptosis?

Children with ptosis should be examined by an ophthalmologist. Based on the results, he or she will recommend the most appropriate treatment. In some cases, the child might be referred to an oculoplastic surgeon, a specialist in ophthalmic plastic and reconstructive surgery.

If you develop ptosis later in life, then you may need to see an ophthalmologist, or in some cases a neurologist too. What doctor you should visit will depend on the symptoms you have. If the drooping eyelid is accompanied by double vision, pain, or muscle weakness, you might need to be examined by a neurologist.

If you simply want to correct your drooping eyelids due to cosmetic reasons, then it is best to consult a plastic surgeon who has experience with cosmetic eye procedures.

How is eyelid drooping diagnosed?

In your consultation, the doctor will ask you about your medical history and all of the complications you have. This may include questions about whether ptosis is constant or your upper eyelid droops from time to time. The physician will also want to learn whether you have any other complications such as pain or blurry vision. Then he or she will examine you and order the necessary tests.

Some of the exams that you might have are the so-called slit lamp exam and the Tensilost test. Keep in mind that, in some cases, your doctor may need to dilate your eyes to do the slit lamp exam. So it is good to get someone with you when going to your appointment.

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