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 (pronounced TOE-SISS) 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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  • before pictures of drooping eyelid surgery

    Contact lens related ptosis

  • swelling following drooping eyelid correction surgery

    Immediately following surgery

  • 4 weeks following drooping ptosis eyelid correction

    After surgery. The swelling has disappeared

  • after drooping eyelid surgery again

    The surgical wound disappears in time

2. In children
Ptosis can be present at birth (congenital ptosis) as a result of abnormal foetal 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”.

  • contact lenses causing drooping eyelid

    Left upper eyelid ptosis due to contact lens wear.

  • contact lens causing drooping eyelid

    2 weeks following surgery

Symptoms and Signs of Ptosis

Before Ptosis Surgery Before Ptosis Surgery
After Ptosis Surgery After Ptosis Surgery

Severe eyelid ptosis of both upper eyelids: this lady's eyelids are so droopy that they interfere with her vision even when looking ahead.

  • 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 a possible cause of the ptosis.

Non surgical methods for patients who don't want surgery or who aren't suitable for surgery e.g. using ptosis props or Lundi loops. These are typically fitted by specialist opticians.

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). Some surgeons prefer to offer this operation via a posterior approach, by making an incision in the back of the eyelid.
  • 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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  • before drooping eyelid surgery

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

  • 1 week after drooping eyelid surgery

    1 week following surgery

  • following droopy eyelid surgery

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

Before and after pictures of Ptosis Surgery

  • before cosmetic eyelid surgery

    Before Upper and Lower Blepharoplasty Surgery with Ptosis Correction for cosmetic improvement

  • 1 week after bilateral ptosis correction surgery

    2 weeks following surgery

  • before cosmetic ptosis surgery

    The patient remarked how her friends were amazed with the subtle natural looking improvement

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    Ptosis due to previous trauma

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    4 weeks following surgery.

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    Contact lens related ptosis

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    2 weeks following surgery

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    Note the tiny wound which often disappears

  • before ptosis correction surgery

    Age related ptosis of both upper eyelids

  • eyelids after ptosis correction surgery

    2 weeks following surgery

..Now I understand why there’s a waiting time to see you and for surgery! You were so worth the wait though. I bit more expensive than my local plastic surgeon but so much more thorough. The plastic surgeon I saw before I saw you didn’t do half the tests that you did. I had total confidence in your care. Now to save up for my lowers! Thanks so much David!
Miss MB (Bristol). Surgery performed: Bilateral upper eyelid blepharoplasty with ptosis correction under local anaesthetic at the BMI Edgbaston Hospital, Birmingham