The eyelid is a structure that protects the surface of the eye and allows the eye to open and close during vision. An eyelid drooping (ptosis) refers to when the upper eyelid is positioned lower than it should be. A drooping eyelid not only causes aesthetic concerns but can also lead to a narrowed visual field, eye fatigue, and difficulties in daily activities. Eyelid drooping can occur unilaterally or bilaterally.
What is Drooping Eyelid (Ptosis)?
Eyelid drooping (ptosis) occurs as a result of the loss of function in the muscle that lifts the eyelid and the nerves controlling this muscle. In this situation, the visual field may narrow, requiring the person to tilt their head backward or constantly raise their eyebrows to see better. Ptosis can affect one or both eyes. The droopiness can be mild or significant enough to obstruct vision.
This condition not only causes an aesthetic difference in appearance but, especially in cases of marked ptosis:
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Visual function may be affected
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Eye fatigue can develop
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Daily living activities may become challenging
What Causes Eyelid Drooping?
The primary structure that lifts the upper eyelid is the levator muscle. Weakening, stretching, or lack of neurological stimulus of this muscle causes the eyelid to sit lower than normal.
The main factors contributing to the development of eyelid drooping are:
Age-related Muscle and Connective Tissue Weakening
With aging, relaxation of the muscles and tendons that lift the eyelid may occur. This process, along with the loss of skin elasticity, can lead to the sagging of the eyelids over time.
Congenital (Congenital) Ptosis
This can be observed in infants due to insufficient development of the muscle that lifts the eyelid. Early diagnosis is essential to avoid the development of lazy eye if untreated.
Trauma or Post-operative Ptosis
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Blows to the eye area,
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Impact on the muscle during cataract, retina, or eyelid surgeries,
may prevent the levator muscle from performing its function.
Prolonged Use of Contact Lenses
In individuals using rigid lenses, the regular insertion and removal of lenses may exert mechanical pressure on the levator muscle, leading to the downward sagging of the eyelid over time.
Nerve or Muscle Diseases
Certain neurological or systemic diseases can cause ptosis:
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Myasthenia Gravis (muscle weakness)
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Horner Syndrome
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Diabetes or nerve conduction system diseases
In these diseases, the muscle cannot produce the power to lift the eyelid, leading to ptosis.
Botox Applications
Incorrect or inappropriate Botox applications to the brow area can affect the muscle that lifts the eyelid, causing temporary ptosis.
What are the Symptoms of Drooping Eyelid (Ptosis)?
A drooping eyelid (ptosis) can lead to a narrowed visual field due to the upper eyelid being positioned lower over the pupil than normal. This situation can cause behaviors such as inadvertently lifting the head or frowning to sharpen vision throughout the day. In advanced cases of eyelid drooping, daily activities may become challenging, and the feeling of eye fatigue may increase.
Symptoms of eyelid drooping include:
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The eyelid appearing droopy in one or both eyes
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Reduction in the visual field
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A feeling of heaviness in the eyes
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Constantly raising the eyebrows
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Dry eyes and excessive tearing
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Blurred vision and difficulty focusing
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Eyes appearing different sizes
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Risk of developing lazy eye (amblyopia) in children
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Attempting to correct vision by tilting the head backward
In children, ptosis can obstruct visual development if the eyelid covers the pupil, hence early diagnosis is crucial.
How is Eyelid Drooping Diagnosed?
Eyelid drooping (ptosis) is diagnosed by an ophthalmologist by evaluating the patient's complaints and the position of the eyelid. The aim of the diagnostic process is to determine whether the drooping is due to muscle, nerve-related, or another eye or systemic condition.
Evaluations performed for diagnosis include:
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Measurement of Eyelid Level: The specialist assesses how much the eyelid covers the pupil in millimeters. This measurement may help determine the degree of ptosis.
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Assessment of Muscle Function: The strength of the levator muscle that lifts the eyelid is tested. If the muscle does not move sufficiently, the surgical plan is made accordingly.
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Visual Field Test: It is checked whether eyelid drooping causes a reduction in the visual field. In advanced ptosis cases, patients may experience significant loss in the upper visual field.
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Eye Examination and Eye Health Check: It is evaluated whether the eyelid drooping is associated with lens usage, past surgeries, or another problem related to the eye surface.
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Additional Neurological and Muscle Conduction Tests: Further investigation may be planned if myasthenia gravis or neural causes are suspected.
What are the Treatment Options for Eyelid Drooping (Ptosis)?
Ptosis is not only an aesthetic problem; treatment is usually a medical necessity as it affects the visual field. The primary aim of treatment is to restore the upper eyelid to its natural position, expand the visual field, and provide the eye with functional and correct movement.
The most effective and permanent treatment option for eyelid drooping is surgery. During surgery, the levator muscle that lifts the eyelid is strengthened or repositioned if necessary. If the muscle function is adequate, the levator muscle is shortened, lifting the eyelid higher.
In cases where the levator muscle does not perform its function, particularly in congenital ptosis cases or adult patients with severely weakened muscle function, the frontal suspension technique may be preferred. In this method, the eyelid is attached to the forehead muscles with thin suspension material, enabling lid movement with the help of forehead muscles.
Non-surgical treatments can provide limited and temporary benefits. In cases of temporary ptosis developed after Botox application , some eye drops may help lift the eyelid slightly; however, this method is not permanent. Therefore, in eyelid drooping affecting quality of life and vision, surgical intervention is considered a permanent solution.
Frequently Asked Questions
Does eyelid drooping resolve on its own?
If eyelid drooping (ptosis) occurs due to muscle weakness or nerve involvement, it does not heal on its own. This situation can progress and affect the visual field. A permanent solution is most often achieved through low eyelid surgery.
Is eyelid aesthetics the same as low eyelid surgery?
No. Blepharoplasty involves removing excess skin and fat tissue from the eyelid. Low eyelid surgery aims to strengthen the muscle that lifts the eyelid. While the two procedures may seem similar aesthetically, they differ in purpose and technique; both procedures may be performed simultaneously in some patients.
Why do eyelids swell?
Allergic reactions, sinusitis, lack of sleep, excessive salt consumption, eye infections, and prolonged screen time can cause eyelid swelling. Swelling is usually temporary; however, if it recurrs frequently, it should be evaluated by an ophthalmologist.
What is double eyelid?
A double eyelid refers to an eye structure where there is a prominent crease in the upper eyelid. This crease is naturally distinct in some individuals; it can also be surgically created in some aesthetic procedures. This procedure is regarded as part of eyelid aesthetics and differs from ptosis treatment.