What is Ptosis (aka EyeLid Drooping)?

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Eyelid drooping is also called ptosis (silent “p”). Dermatochalasis is very, very similar but technically refers only to the excessive and redundant upper eyelid skin that droops over the lid margin. Both can obscure vision.

Ptosis occurs when the upper eyelid hangs down and sags or droops over the eye. Ptosis is not painful, but the eyelid can droop so low that it blocks sight and people with extreme eyelid drooping may have to tip their head back in order to see more clearly.

Sometimes babies are born with ptosis. In some cases, a child born with ptosis has other eye-related problems. Surgery to tighten the muscle that controls the eyelid or attaching the eyelid to other muscles is recommended to correct ptosis in children.

What causes ptosis?

  • Weakness of the muscle that raises the eyelid
  • Excessive looseness of the skin of the upper eyelid caused by aging
  • Damage to the nerves that control the eyelid muscles
  • Swelling in the eyelid caused by a stye
  • Tumor around or behind the eye
  • Stroke

How is eyelid drooping treated in adults?

If the ptosis is not affecting your vision and you don’t mind the appearance of the drooping eyelid then no treatment is needed. However, if the ptosis is obstructing your vision or you don’t like the appearance of the drooping eyelid then you could opt for surgery or a prescription treatment.

Surgical treatment for eyelid drooping

There are several corrective surgical approaches to fixing ptosis and each of them take about an hour. The levator muscle can be tightened by repositioning it and sitting it in place to the connective tissue in the eyelid. Another approach is to shorten one of the two muscles that lift the eyelid. In another surgical approach the upper eyelid can be attached by a rod to the frontalis muscle—the muscle just above the eyebrows. Connecting the eyelid to the frontalis muscle with a rod allows the forehead muscles to elevate the eyelid.

When done by an experienced surgeon the success rate for ptosis surgery is very high—90-95%. The type of ptosis repair surgery chosen depends on what is causing your ptosis. After any type of ptosis surgery, you should limit your activities for about a week as your eye heals. You should also avoid rubbing your eye during the healing process. Bandaging the eye is not necessary.   

Non-surgical ptosis treatment

In 2020 the FDA approved an eyedrop—Upneeq—to treat ptosis. The eye drops contain oxymetazoline which is the same ingredient in the nasal spray Afrin. The eyedrops must be reapplied once a day to maintain the uplifting effect on your eyelid. But unlike Afrin, which is not safe for long-term use, Upneeq can be used indefinitely. The active ingredient is oxymetazoline and it makes the eyelid muscle temporarily shorter and tighter.

Before deciding to use any medication your eye care doctor will weigh the risks and benefits and ensure that you are not taking any medication that would interact with it and cause complications. 

Gregory Scimeca, M.D.
Ophthalmologist and Medical Director
The Eye Professionals

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