WHAT IS A DROOPY EYELID?

Droopy eyelids, known medically as ptosis, is a condition in which the border of either one or both of the upper eyelids droops to a lower position than is normal. This can cause unwanted cosmetic problems, giving people the appearance of a tired look. In more severe cases, it can also cause vision problems if the droopy eyelid covers some or all of the eye, as well as, other conditions such as dry or watery eyes.

WHAT ARE THE SYMPTOMS OF EYELID PTOSIS?

The obvious symptom of ptosis is a drooping eyelid, which can affect one or both eyes. In children with congenital ptosis, the clues to look for are the tilting of their heads back or raising of their eyebrows and chin to lift the eyelids and see clearly. This often results in headaches and neck pain.

The severity of the condition varies from person to person, but typically patients experience the following symptoms:

• Finding it difficult to keep eyelids open
• Eye fatigue, especially when reading
• Strained eyes
• Eyebrow ache as a result of the great effort required to raise the eyelids

WHAT CAUSES DROOPY EYELIDS?

Ptosis usually occurs in adults due to a dysfunction of the eyelid muscles that lifts the lid causing the eyelid drooping. Eyelid ptosis can be hereditary (congenital ptosis), which affects a person from birth and means there is a defect with the levator muscle which raises the eyelids. Congenital ptosis can be mild or severe, but a person can suffer permanent damage to vision if left untreated.

Some small children may have Marcus Gunn ‘jaw-winking- ptosis, where the droopy eyelids raise when the jaw is opened. The reason for this is due to an abnormal nerve connectivity and usually only affects one eyelid.

The condition can also affect adult patients later in life (acquired ptosis), due to age, eye trauma, cataract surgery or contact lens wear, which injures the levator muscle as lenses are repeatedly inserted into the eyelid.

Various neurological conditions can cause droopy eyelids, such as myasthenia gravis or myotonic dystrophy, but these are less common. Eyelid droopiness may also occur when they are weighed down by swelling or large cysts.

Unfortunately, it is not possible to prevent ptosis in most cases, and in patients with age-related ptosis, the droopiness can gradually worsen as time goes on.

HOW IS PTOSIS SURGERY PERFORMED?

Surgery for ptosis usually involves the shortening of the muscles or tendons that raise the eyelid. A hidden incision will be made in the natural skin crease of the upper eyelid. It can also be performed through the underside of the eyelid, forgoing the need for a skin incision.

The key step in a droopy eyelid treatment procedure is identifying the muscle controlling the lifting of the eyelid, which is then advanced and reattached to the lid. In other, rarer forms of ptosis, a suspension to the brow is performed, whereby the lifting of the brow region is mechanically coupled to the eyelid.

The Ptosis surgical procedure is normally carried out under local anaesthetic (general anaesthetic for children) and takes around 45-90 minutes, depending on whether one or both eyelids are being treated. After 1-2 weeks, the sutures can be removed.

It is also commonly performed with upper eyelid blepharoplasty to provide an optimal appearance of the upper eyelid and to improve vision. Brow lift surgery is also often carried out at the same time to achieve a good cosmetic result.

WHAT TYPE OF ANAESTHETIC IS USED IN PTOSIS SURGERY?

Adults undergoing droopy eyelid surgery will usually be given local anaesthetic and will be awake during the procedure. This allows the surgeon to better judge the lid positioning. Sometimes, local anaesthetic with sedation or general anaesthetic will be used.

For children, ptosis surgery is typically performed under general anaesthetic. Patients should not have anything to eat or drink for at least six hours prior to the surgery.