Ptosis is the medical term for drooping of the upper eyelid, a condition that may affect one or both eyes. Ptosis that is present since birth is called congenital ptosis. The ptosis may be mild – in which the lid partially covers the pupil; or severe – in which the lid completely covers the pupil. Depending on how much of the pupil is covered, there maybe a mild to severe reduction of the upper field of vision. Some patients compensate for a partial loss of their upper field of vision by raising their eyebrows in order to help lift their droopy eyelids.
Droopy eyelids (ptosis) occur when the edge of the upper eyelid falls from its normal position. When the edge of the eyelid falls too low and covers part of the pupil, it can block the upper part of your vision. In severe cases it may be necessary to tilt one’s head back or lift the eyelid with a finger in order to see out from under the drooping lid. In most cases, a drooping upper eyelid results from aging of previously normal structures. Typically, the tendon of the muscle responsible for lifting the eyelid stretches and the eyelid falls.
Surgical correction of a drooping upper eyelid involves repairing the stretched tendon. It is not uncommon for one to develop a droopy upper eyelid following cataract or other eye surgeries. Acquired ptosis is most often treated by oculoplastic surgeons.
Children with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows in an effort to see from under their drooping eyelid(s). While the cause of congenital ptosis is often unclear, the most common reason is improper development of the levator muscle. The levator muscle is the major muscle responsible for elevating the upper eyelid.
Children with congenital ptosis may also have amblyopia (“lazy eye”), strabismus (eyes that are not properly aligned or straight), refractive errors, astigmatism, or blurred vision. In addition, drooping of the eyelid may result in an undesired facial appearance. Congenital ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the strength of the levator muscle. If the ptosis is not severe, surgery is generally performed when the child is between 3 and 5 years of age (the “pre-school” years). However, when the ptosis interferes with the child’s vision, surgery is performed at an earlier age to allow proper visual development.
Congenital ptosis is most often treated by oculoplastic surgeons.