Conditions: Eyelid ptosis (Adult) 2017-09-28T11:32:10+00:00

Eyelid ptosis (Adult) Overview

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The best way to figure out whether your specific condition can be treated or not is to give us a call. We can answer any questions you have and help you clarify which treatment options might be suitable for you.

There are different treatment options available for this condition and the most common ones are listed below:

  • Upper lid crease incision

  • Posterior Eyelid Incision

  • Botulinum Toxin

  • Eye drops

Learn more about treatment options

Eyelid ptosis (Adult)

What is an Eyelid ptosis (Adult)?

Drooping eyelids are called ptotic eyelids. Eyelid ptosis in adults is usually a result of ageing that affect the muscles in the eyelid that are designed to lift the upper eyelid. Eyelid ptosis can also occur in younger adult patients, especially those who wear contact lenses, due to a continuous micro trauma from insertion and removal of the lenses.

In rare cases eyelid ptosis can be related to a neuromuscular disease. Eyelid ptosis can also occur with the use of some drugs, following eyelid trauma or with the extra weight of an eyelid lump such as a large chalazion or tumour.

The levator and Muller’s muscles, which lift the eyelid, are shown below:

Treatment

The only permanent way to treat eyelid ptosis is with surgery. There are several possible surgical techniques:

Upper Lid Crease Incision

Usually, eyelid ptosis is treated via a single skin incision, hidden within the crease of the upper eyelid. Once the incision is made, the small muscles that lift the eyelid are identified and adjusted as necessary to correct the drooping eyelid. On occasion, excess amounts of drooping skin can be removed at the same time (called a blepharoplasty).

Posterior Eyelid Incision

In some cases, the same outcome can be achieved via an incision in the reverse surface of the eyelid (conjunctiva). Again, a blepharoplasty can be done simultaneously if necessary.

Other treatments

Occasionally botulinum toxin A (eg. Botox®) or eye drops can be used to temporarily rectify minor upper eyelid ptosis.

Video: Eyelid ptosis (Adult) explained

Examination for Eyelid ptosis (Adult)

A full ophthalmic examination is performed to check visual function, eye movement, the eyelid condition and the ocular surface. Then a full face examination is performed. It is common for photographs to be taken.

Special eyelid measurements are taken and a phenylephrine test is performed to assess the degree and type of ptosis. This helps decide the specific surgery that may be required.

The surface of the eye and the lids will be assessed using a slit lamp to check for signs of dryness. Drops may be used to dilate the pupil. Occasionally, it may be necessary to order a visual field test if there are vision problems.

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Frequently Asked Questions

Eyelid ptosis surgery is usually performed as a day case and will not require an overnight stay.

It is done under local anaesthetic, with or without sedation. This allows the oculoplastic surgeon to adjust the height of the eyelid whilst the patient is awake, optimising success. The operation takes up to one hour per eyelid. If there is both ptosis and excess upper eyelid skin, both ptosis surgery and a blepharoplasty will be done simultaneously.

Local anaesthetic will be injected into the eyelid, numbing it. This injection can sting slightly.

Patients may be given sedation before the injection to make them drowsy so they don’t feel the injection. Most patients claim to feel little or no pain during surgery. You will be aware of some sensations such as pressure, although these do not cause discomfort. After the operation, the eyelid may ache for a few days. Painkillers such as paracetamol and ibuprofen will settle this.

The eyelids are often bruised and this can take two to three weeks to clear. There may also be some residual mild swelling for up to six weeks.

It often takes several months for the lids to settle into their new position, and only then can the effectiveness of the surgery be assessed. The scars will fade gradually, but in any case are very small and tend to be hidden within the crease of the eyelid.

This depends on the nature of your work. There may be bruising and swelling after surgery and some discomfort.

Avoid strenuous activity, heavy lifting and swimming for at least two weeks after surgery. You should not drive or operate machinery for 48 hours after a general anaesthetic and 24 hours after intravenous sedation.

Normally, you will be reviewed six to ten days after surgery and on one or two further occasions after that, up to three months after surgery.

As with all surgery, there is a small risk of complication. Serious complications such as infection, bleeding or loss of vision are extremely rare.

A temporary inability to fully close the eye is common during the first few days, especially if the eyelid ptosis is pronounced. Whilst good symmetry between the two eyelids is normally achievable, sometimes it is not possible. Occasionally, more than one operation is necessary to achieve the best result.