Ptosis or drooping eyelid is a common eyelid disorder. The upper eyelid usually covers the black eye by no more than 2 millimeters. As observed when the eye is normally opened, the lower edge of the upper eyelid is slightly covered by the upper black eye without having to raise your eyebrow. Ptosis may occur in one or both eyes. Occurrence in both eyes will make the patient look like a sleepy person. 

Symptoms

In general, ptosis do not have painful symptoms but will affect the quality of life in the sense that the patient experiences a decrease in vision due to the lower than normal upper eyelid. Ptosis may occur on one side at a time or simultaneously on both sides. Patients may try to observe their own symptoms by looking at their own eyes in the mirror. In normal cases, the pupils are clearly visible and all black eyes are visible. However if there is a drop in the eyelids, the eyes are smaller than usual and only half the black eyes are visible.

If you suffer from severe diseases such as myasthenia gravis, other symptoms may occur, such as blurred vision, weak arms or legs, difficulty speaking, breathing or swallowing. 

Ptosis in children may be diagnosed as Amblyopia. If the eyelid falls significantly, it may block vision or cause blurred vision or strabismus, which may affect eye movements.

Causes

• Congenital ptosis from genetic or abnormalities during pregnancy. 

• Ptosis from the ligaments of the muscles that lift the eyelids. This causes the eyelid muscles to become weak and excess fat accumulates in the eyelids and under the eyes resulting in eyebrows fall, eyelids fall, and bags under the eyes. Most common cause for adults.

• Ptosis due to musculoskeletal and neurological disorders such as muscle weakness or nerve inflammation. 

• Eyelid falls due to behaviors that cause eye muscles to stretch or injured, such as eye allergies, frequent eye rubbing, wear contact lenses with inappropriate curvature, contact lenses allergy due to poor cleaning, or wearing contact lenses for a long duration.

• Ptosis from eye surgery that affects the muscles in the eye opening. 

Treatment

In cases of blocked vision or affecting appearance, most common procedure is the eyelid surgery which handles the problem with eyelid lift surgery, and the surgical procedure uses minimal anesthesia.

For newborns with severe ptosis, an Ophthalmologist may recommend corrective surgery immediately because if treated quickly, it will permanently reduce the risk and potential damage to vision. In cases where the symptoms are mild or assessed to be non-affecting to the vision, the ophthalmologist may recommend waiting until the child is 3-5 years old to be treated.  

In the case of ptosis that are mainly caused by muscle or neurological diseases or problems in the eye area, the doctor will treat the disease first. Ptosis may be better or do not progress in some cases.

Treatment

Ptosis reduces ability to see and makes the person look old becoming concerns in many people in present context. Ptosis surgery is an option to brighten up overall facial expression.

The doctor will perform eyelid surgery to adjust the adhesion position or increase the lifting force of the fascia, which may be performed in conjunction with surgery on parts of the skin of the sagging eyelids obscuring vision, or lifting the deep fascia of the face especially the eyebrow area. 

However, the treatment of ptosis with eyelid surgery is at the discretion of the doctor. Consult your doctor to understand the diagnosis and consider the options against the expected outcomes to make the right decision.  

When to see a doctor?

Ptosis is usually mild but will affect daily life significantly by obscuring vision and affect self-confidence in appearance. An ophthalmologist can recommend accordingly to patient’s expectations. However, if you have certain conditions with ptosis, you need to see your ophthalmologist immediately:

• Sudden eyelid fall within 2-3 days or 2-3 hours

• Severe headache, double image, weak facial muscles, weak arms and legs, difficulty speaking or swallowing

• Eye inflammation and irritation including eye pain and redness or difficulty rolling eyes