Ptosis is when the upper eyelid droops over the eye. The eyelid may droop just a little, or so much that it covers the pupil (the black dot at the center of your eye that lets light in). Ptosis can limit or even completely block normal vision.
Children and adults can have ptosis. Fortunately, this condition can be treated to improve vision as well as appearance.If amblyopia is not treated in early childhood, it may lead to permanent vision loss later in life.
Ptosis in children
The most obvious sign of ptosis is a drooping eyelid. Another sign is when the upper eyelid creases do not line up evenly with each other. A child with ptosis may tip their head back, lift up their chin, or raise their eyebrows to try to see better. Over time, these movements can cause head and neck problems.
Sometimes, a child born with ptosis can also have other eye-related problems. They can include eye movement issues, eye muscle disease, tumors (on the eyelid or elsewhere) and other problems.
Having ptosis puts a child at risk for vision problems. If the child’s eyelid droops so much that it blocks vision, amblyopia (also called “lazy eye”) can develop. One eye will have better vision than the other. A child with ptosis can also have astigmatism, where they see blurry images. The child may also develop misaligned (crossed) eyes.
Ophthalmologists consider the following factors when deciding the best way to treat ptosis in children:
- The child’s age
- Whether one or both eyelids are involved
- The eyelid height
- The strength of the eyelid’s muscle
- The eye’s movements
In most cases, ophthalmologists recommend surgery to treat ptosis in children. This is to either tighten the levator muscle or attach the eyelid to other muscles that can help lift the eyelid. The goal is to improve vision.
If the child also has amblyopia, that condition must be treated as well. Amblyopia may be treated by wearing an eye patch or special eyeglasses, or using certain eye drops, to strengthen the weaker eye.
All children with ptosis—whether or not they have surgery—should see their ophthalmologist regularly for eye exams. Ask your child’s ophthalmologist how often exams are needed. Because kids’ eyes grow and change shape, they need to be checked for amblyopia, refractive disorders, and other eye problems.
Ptosis in adults
Adults get ptosis (called involutional ptosis) when the levator muscle stretches or separates away from their eyelid. This can be caused by aging or an eye injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.
Your ophthalmologist will find the cause of your ptosis in order to recommend treatment. They will do a complete eye exam, and may also want you to have blood tests, X-rays, or other tests. The ophthalmologist will likely recommend surgery to help the eyelid muscle work better.
The most obvious sign of ptosis is the drooping lid itself. Ptosis can affect one or both eyelids. It may be present at birth (congenital) or occur later in life. In congenital ptosis, the upper eyelid creases may appear asymmetrical.
Children with ptosis may also often tip their head back into a chin-up position to see underneath the drooping eyelid, or they may raise their eyebrows in an attempt to lift up the lids. Both of these positions are signs that the child is trying to use both eyes to see. Over many years, abnormal head positions may cause deformities in the head and neck.
What Causes Ptosis?
Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as neurological and muscular diseases and, in rare cases, tumors of the eye socket.
Congenital ptosis is often caused by poor development of the levator muscle that lifts the eyelid. Although it is usually only a problem with a drooping eyelid, a child born with ptosis may also have eye-movement abnormalities, muscular diseases, lid tumors, or other tumors, neurological disorders or refractive errors.
Ptosis surgery is done as an outpatient procedure in your ophthalmologist’s office. A local anesthesia will be used to numb your eye and the area around it.
Sometimes, the surgeon may only need to make a small adjustment to the lid’s lifting muscle. Extra skin from the eyelid also may be removed to help the eyelid lift properly. For more severe ptosis, the levator muscle may need to be strengthened and reattached to the eyelid.
As with any type of surgery, there are possible risks and complications with ptosis repair. Your ophthalmologist will discuss these with you.
Before eyelid surgery, be sure to tell your ophthalmologist about all the medicines you take. Include all prescription and over-the-counter medications, vitamins, and supplements. It is important for your eye surgeon to know if you take aspirin (or aspirin-containing drugs) or blood thinners, or if you have a bleeding problem.
All information and images provided by: EyeSmart® a division of the American Academy™ of Ophthalmology