Ptosis

It can affect one or both upper eyelids and may not be symmetrical. It is different to excess, droopy skin of the upper eyelid, although both can occur together. The ptosis can obstruct the top part of your visual field or reduce light entering the eye. It can also cause difficulty in keeping the eyelids open, eye strain or brow ache from compensatory effort to raise the eyelids, or fatigue particularly when reading.

Ptosis can be either present at birth (congenital) or appears later in life (acquired).

Congenital ptosis affects a child from birth and is commonly due to a defect in the major muscle that raises the eyelid. In children, surgical repair of the ptosis may be imperative due to the effect on visual development. This type of ptosis may also be associated with ‘jaw-winking’ where the droopy eyelid rises when the jaw opens.

Acquired ptosis which develops later in life can be due to a defect in the muscle or nerves of the eyelid. The most common cause is age related stretching of the attachment of the major muscle that lifts the eyelid (levator aponeurosis). Other causes include previous eye surgeries, injury and long-term contact lens wear. Less commonly, it can result from serious neurological disorders (e.g. stroke, Horner’s syndrome) or muscular conditions (e.g. myopathies, myasthenia gravis), which require additional investigation. A thorough clinical assessment in clinic will help identify the cause and determine the appropriate treatment. This may include review of old photographs, taking new photographs, visual field testing, an eye movement assessment, eye drop testing, and/or blood tests.

Most cases of ptosis can be corrected surgically, usually by tightening the major eyelid muscle. Occasionally, severe cases with poor eyelid muscle function require other techniques such as frontalis suspension where the eyelid is suspended from the brow to help raise it. In rare circumstances such as myasthenia gravis, oral medication may improve the ptosis without the need for surgical intervention.

In general ptosis surgery is very safe, however as with all surgery certain risks and complications can occur:

Our surgeons have extensive experience and expertise in ptosis surgery utilising minimally invasive techniques that reduce both scarring and healing time. For most patients there is an 80-90% chance of a successful outcome with one operation. The goal is to raise the eyelids to allow for an improved visual field and to increase symmetry between the eyelids. Post operatively it is helpful to expect an improvement in symptoms and appearance of the lids rather than a complete change in appearance, with a refreshed natural look that is not overdone.