Droopy Eyelids Ptosis Eyelid Drooping

Baltimore Washington Eye Center, Maryland

Tuesday, November 15, 2011

Droopy Eyelids-Help, I Can Barely Open My Eyes!

Some people have eyelids that droop so much that they can barely see and they need to use their brow to help raise their lids or even pick their chin up so that they can see better. I often hear the complaint "People always ask me if I'm tired" or "My husband thinks I am asleep." Sometimes people work so hard to keep their lids lifted that they get headaches as a result. This drop in the height of the upper eyelid, also known as ptosis (pronounced TO-sis), is very different from the excess eyelid skin, medically referred to as dermatochalasis.

There are different causes of ptosis, but the most common is involutional ptosis caused by aging.  As we age, the muscle tendon that attaches to the firm part of the upper eyelid (known as the tarsal plate) starts to lose its strength. It pulls away from its normal anatomic attachment, which weakens its ability to raise the upper eyelid.  As a result, patients see a higher eyelid crease and an upper eyelid that comes down and covers some or their entire pupil, blocking part of their vision. In order to raise the upper lid, surgery is performed to reattach the muscle that elevated the lid (the levator muscle) to the tarsal plate. This is done by making a skin incision in the upper lid along the eyelid crease and then dissecting down into the substance of the lid to find the levator and sew it back to its proper position on the tarsal plate. Then the skin incision is closed using dissolvable sutures. 

Another not uncommon cause of ptosis is congenital ptosis; this is generally present in childhood and results from a poor development of the levator muscle and it is too weak to lift the lid properly so it stays droopy.  Surgery in these cases is different than that for involutional ptosis and is typically performed by a pediatric ophthalmologist. Lid lesions, eyelid swelling, trauma, among other things are common causes of mechanical ptosis; this means that there is something in or on the upper lid that is weighing it down. In these situations, the treatment actually consists of treating the cause of whatever is pushing the lid down, rather than treating the muscle of the upper lid.

Often during a lid evaluation for ptosis, additional testing such as taped and untaped visual fields may be performed to determine if the droopy eyelid is blocking part of your vision.