Ptosis–an upper eyelid that droops–is an annoying condition that can affect one or both lids. (Pronounced TOE-sis, the word comes from the greek and means “falling.”) The lids may sag so much they block the line of sight. Some people get a headache from the effort to hold their lids open wider. But ptosis is usually not serious unless the lids interfere with vision.

before copy
This a 50 year old Female with Obstruction of Superior Vision

Same Patient after Eyelid Surgery

A muscle (the levator) holds the upper eyelid in proper position and moves it up and down. Any condition that affects this muscle will also affect the lid position. Most cases of ptosis in an adult come on gradually during the later years of life, as part of the normal aging process. The levator tendon (fibrous connection between the levator muscle and the lid) stretches, thins, or loosens its attachment to the eyelid, causing it to sag. This age-related ptosis is called involutional. Less common causes include injury, previous eye surgery, and neurological a systemic condition, such as diabetes. Occasionally, a drooping lid in an adult has actually been present since birth (congenital) but was never treated. Blood test, X-rays, or other tests are sometimes needed to determine the cause of a ptosis. If treatment is indicated, the test can help with planning the best type of treatment.
Sometimes the operated eyelid does not close well for a few weeks after the surgery, especially when you are asleep. Excessive exposure to air can cause the surface of the eye to become dry, resulting in a burning or scratchy sensation. The problem is usually temporary, and lubrication drops and ointments can be prescribed to alleviate the dryness and the discomfort. If it persists (which is rare-most likely when the ptosis was severe or when the levator muscle is very weak), the lid may need to be lowered surgically.

Less likely is the possibility that the levator muscle will not respond as expected, resulting in lid positions that do not “match” one another. If that happens, a second operation may be necessary to readjust the alignment.

As with any surgery around the eye, there is a small risk for bleeding, infection, scarring, double vision, or even loss of vision. Fortunately, these complications are very rare, and if they are discovered quickly, most can be treated successfully.

After the stitches (sutures) are removed and the swelling has subsided, your may be surprised not to see any scars. That is because the incision site is usually hidden in a natural eyelid crease or on the underside of the upper lid.

The surgical correction of ptosis is normally uncomplicated and achieves the desired result. Most patients are delighted with their improved appearance and their clear, unobstructed vision.