Ptosis (Drooping Eyelid)

What is Ptosis (Drooping Eyelid)?

Ptosis is a drooping of the upper eyelid below its normal position. It ranges from mild (barely noticeable) to severe (the lid covers the pupil completely). In children, severe ptosis must be treated urgently to prevent amblyopia (lazy eye). In adults, ptosis may cause visual field obstruction, a tired or asymmetric facial appearance, and the need to tilt the head back or raise the eyebrows to see clearly. Oculoplastic surgery is highly effective at correcting ptosis.

Symptoms

• One or both upper eyelids drooping lower than normal
• Reduced or obstructed upper visual field
• Compensatory chin-up head posture or brow raising
• Fatigue of the eye on prolonged upward gaze
• In children — amblyopia, astigmatism, or head turn

Causes

• Aponeurotic ptosis — age-related dehiscence of the levator aponeurosis; the most common cause in adults
• Congenital ptosis — deficient development of the levator muscle, present from birth
• Mechanical ptosis — weight of an eyelid lesion (tumour, chalazion, dermatochalasis)
• Neurogenic ptosis — Horner syndrome, third nerve palsy
• Myogenic ptosis — myasthenia gravis, chronic progressive external ophthalmoplegia
• Trauma or previous eyelid surgery

Diagnosis

Clinical assessment including measurement of margin reflex distance (MRD1), levator function, and upper visual field testing. Systemic causes are excluded where indicated. In children, urgent assessment for amblyopia.

Treatment

Surgical correction is the definitive treatment. Levator advancement is used for good levator function; frontalis sling (attaching the lid to the brow muscle) for poor levator function. NHS funding is available when formal visual field testing confirms significant superior field restriction. Private surgery provides the alternative for cosmetic correction or faster access.