Ptosis of the eyelid is typically caused by weakening or slippage of the muscles that elevates the eyelid.  There are two main muscles, the levator palpebrae superioris (usually referred to as the levator) and Mueller’s muscle that elevate the eyelid.  When the eyelid is droopy, there is often compensatory forehead and brow lifting to improve vision.  With prolonged effort, you may notice fatigue with prolonged reading, working on the computer, driving or other daily activities.   Other patients complain of a headache or tightness in the forehead which may be caused by excessive lifting of the brows. 

Ptosis of the eyelid should be distinguished from baggy or loose upper eyelid skin (also referred to as dermatochalasis) because each is a separate and distinct entity.  These two conditions often co-exist and should be treated together if both are present, otherwise the aesthetic result will be less than optimal.  The picture below illustrates the difference between eyelid ptosis and dermatochalasis.

The yellow arrow (dermatochalasis) above shows the baggy upper eyelid skin that is touching the upper eyelid and hides the lateral part of the eyelid crease.  The red arrow (eyelid ptosis) shows that that the upper eyelid position is droopy and in fact covers part of the pupil.  Notice that on the left eyelid, there is dermatochalasis but there is no eyelid ptosis.  In this patient, ptosis repair was performed in the right eyelid and an upper eyelid blepharoplasty was performed on both eyelids as show below.  Notice the natural appearance of the upper eyelid crease and symmetric position of the upper eyelids as they rest on the pupil. 

Same patient after bilateral eyelid ptosis repair and bilateral upper eyelid blepharoplasty 

Eyelid ptosis is often a medical condition because the drooping or heavy eyelid may occlude part of the pupil and cause significant loss of superior vision.  Similar to baggy upper eyelid skin (dermatochalasis), eyelid ptosis can result in a superior visual field defect as shown below. 

Loss of superior visual field with eyelid ptosis

When the eyelid is temporarily raised up, you may notice an appreciable improvement in your vision. We may perform a visual field test to determine if your ptosis is causing significant visual impairment. 

 Improvement in superior visual field with the eyelid returned to the normal position. 

The cause of eyelid ptosis should be carefully evaluated.  In children, congenital ptosis is typically caused by a maldevelopment of the levator muscle and in some of these cases, the continued presence of ptosis can cause permanent vision loss by failure of the normal visual system to develop (amblyopia).   Prompt identification and treatment of congenital ptosis is crucial for normal visual development. 

A complete clinical evaluation of a ptosis patient is essential to develop the proper treatment plan.  Your surgeon will review the medical and ophthalmic history,evaluate the function of the levator muscle, the location of the eyelid crease,the brow position and function and perform an eye examination.   Each of these factors willdetermine the type of ptosis repair. 

For minimal degrees of ptosis, we typically use the transconjunctival approach for ptosis repair.  In this technique, the eyelid is lifted by performing surgery on the back (underside) of the eyelid.  The benefit of this approach is that no skin incision is typically performed unless an upper eyelid blepharoplasty is performed simultaneously.   

For more advanced degrees of ptosis, Dr. Korn can perform levator surgery through an incision in the natural eyelid crease.  In this approach, the levator muscle isidentified and advanced to the eyelid skeleton (tarsal plate).  Usually, there is extra baggy upper eyelid skin, and this can also be removed at the same time with an upper eyelid blepharoplasty. 

For more before and after photographs, please visit the photo gallery.