Droopy Eyelid / Ptosis
What is Ptosis ?
Ptosis or droopy eyelid occurs due to dysfunction of muscle which lift the eyelid (levator).
What are the Symptoms and Causes ?
When one gets older, s/he may have noticed the eyelid has dropped. Sometimes, it associated with excess skin on upper eyelid (dermatochalasis) and droopy brow. S/he will notice that reading/ watching TV/ driving is getting difficult towards the end of the day. Some will observe upper corner of the visual field no longer visible. This may become even more obvious after eye surgeries eg. cataract surgery. In addition to the inability to see, people who has ptosis often get comments such as 'you look tired’, ‘ you look sleepy’ from others.
In addition to aging changes of elevator muscle which either weaken or detached from its usual attachment, other cause of ptosis include contact lens wear, trauma, mechanical (lump in upper eyelid causing eyelid to drop), neurological such as third nerve palsy, Horner Syndrome and Myasthenia Gravis.
Important cause of ptosis
While most ptosis are benign, its development may associated with some serious medical conditions that require urgent medical attention
- Develop suddenly over a short period of time
- Droopy eyelid together with double vision
- Associated with pain, redness, bulging eyes or eye movements difficulty
Congenital Ptosis | Ptosis in a Child
Ptosis may happen to a child since birth (congenital ptosis or pediatric ptosis). Child ptosis poses a more dangerous condition as it may disturb the child’s visual development and the child is at risk of developing subsequent lazy eye or ambylopia. Amblyopia means normal looking eye but not able to see well. In addition, if the ptosis is only one side (unilateral ptosis), the child will look asymmetry and hence may be teased by others at school. It will adversely affect the child self esteem and self confidence.
A very under diagnosed condition which Dr. Ho Shu Fen notice among oriental children is lash ptosis. Whilst the opening of eyelid may be adequate, the direction of lashes facing downwards lead one not able to see well. Usually this group of children have single eyelid. Changing the direction of lashes by pressing on the eyelid will allow the child to see better, Usually the child will not complain as they do not know they are not able to see in the first place.
Bilateral droopy eyelid in a child may lead the child to develop a chin up position as s/he not able to see the top. It may strain their neck and potential musculoskeletal tissue which they grow older.
Pre op: Severe ptosis (Droopy eyelid), right more than left.
Post op: He looked more refreshed, energised and can see much better.
Pre op: Severe pre op ptosis with frontalis overaction.
Post op: She is able to see clearly now and both eyes look symmetrical
Pre op: Droopy eyelid, left > Right leading to sad look
Post op: Both eyelid looks symmetrical and better
Pre op: Left ptosis in a young lady who wear contact lenses
Post op: Symmetrical and natural appearance
Pre op: A child with a congenital left upper eyelid ptosis. This can affect the normal development of vision
Post op: symmetrical looking eyes. It is very difficult to take photos of a child
Pre op: Age is never a hindrance. This 85 years old lady present with droopy eyelid especially in the evening stopping her from reading.
Post op: This 85 years old lady recovered well after surgery. Looking more alert and can enjoy reading now.
Pre op: Sometimes, ptosis can develop after cataract surgery as speculum can easily damage the levator muscle
Post op: A symmetrical and natural look.
Pre op: Is eyelid surgery only for woman? No, this man feels that the droopy eyelid has hampered his vision and make people false perceive him as uninterested and tired.
Post op: A pair of natural well elevated eyelid gives patient a sophisticated and interested look.
Pre op: droopy bilateral upper eyelid gives a sleepy appearance
Post op: Both eyes wide open.
Pre op: Left congenital ptosis. This lady hid her eyes under glasses as she was shy about her look.
Post op: One month post op. Symmetrical look. She gains her confidence.
Pre op: Two previous failed surgeries done elsewhere.
Post op: Symmetrical and engaged look on a 80 years old. One is never too old for ptosis surgery.
Pre op: Left congenital ptosis causing patient being teased at school.
Post op: Post frontalis sling with fascia lata, symmetrical look again and the child mix well with friends now.
Pre op: Bilateral severe ptosis. Initially patient taught he is not seeing because of cataract, actually he has no cataract.
Post op: both eyelid looks symmetrical and lifted. Patient's vision is 6/6 post surgery with glasses and no cataract surgeries are required.
Pre op: Left droopy eyelid. Right eye also looks a bit droopy.
Post op: post bilateral asian blepharoplasty and ptosis surgery, much more attractive look.
Pre op: left upper eyelid lump. Noted the sun damaged skin.
Post op: Biopsy showed it is basal cell carcinoma. Reconstruction was performed.
Pre op: Left droopy eyelid makes one look sleepy
Post op: symmetrical looks two weeks post left ptosis surgery.
Pre op: After one failed ptosis surgery somewhere, left eye looks droopy.
Post op: Symmetrical looks post revision left ptosis surgery.
Pre op: Despite two ptosis surgery. right eye looks swollen and low.
Post op: Post right ptosis surgery, it looks much better.
Pre op: Despite one ptosis surgery elsewhere, left eyelid remains drooping
Post op: After ptosis surgery, left eye lifted and symmetrical
Pre op: Left droopy eyelid, was treated as myasthenia gravis for three years.
Post op: Symmetrical look post left ptosis repair and medial epicanthoplasty