Eyelid Disorders/Ptosis

A person with ptosis (pronounced TOE-sis) cannot lift one or both of their eyelids all the way, usually because of a malformed eyelid-lifting muscle. The affected eyelid may droop only slightly, or it may droop enough to partially or completely cover the pupil, restricting or obscuring vision.

Ptosis may be inherited, present at birth, or occur later in life. When ptosis is mild, treatment may be desired for cosmetic reasons, but is not medically necessary. When ptosis is severe enough to obstruct vision, it may result in a condition called amblyopia and treatment is usually beneficial.

Ptosis present at birth is called congenital ptosis. Congenital ptosis is often caused by poor development of the eyelid lifting muscle, called the levator. Although usually occurring as an isolated problem, children born with ptosis may also have eye movement abnormalities, muscular diseases, lid tumors, or neurological disorders. Congenital ptosis usually does not improve with time.

Adult Ptosis

The most common type of adult ptosis is caused by the separation of the levator muscle tendon from the tarsal plate (a structure within the eyelid). This can occur as a result of aging, after cataract or other eye surgery, or from an injury. Adult ptosis may also occur as a complication of other diseases, such as diabetes, involving the levator muscle or its nerve supply. Or, it may occur when movement of the levator muscle is restricted, as may happen in the case of an eyelid tumor.

The most obvious sign of adult ptosis is a drooping upper eyelid. There may be some vision loss in the upper field of vision or fatigue and headaches from attempting to elevate the drooping lid. Patients will often tip their heads back to see past their eyelids or raise their eyebrows in an effort to raise their lids.

Treatment of Adult Ptosis

Your ophthalmologist may use blood tests, X-rays or other diagnostic tests to determine the cause of the ptosis and plan the best treatment. Treatment, when necessary, is usually surgical. When the levator has separated from the tarsal plate, reattachment of the muscle can correct the ptosis. Sometimes a small tuck in the lifting muscle and eyelid can lift the lid sufficiently. More severe ptosis requires greater tightening of the levator muscle.

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