What is Droopy Eyelid?
Droopy eyelid (ptosis) is a drooping of the upper eyelid, causing it to cover the eye more than normal. The patient has difficulty opening their eyes normally, which often causes fatigue at the end of the day and can impair vision, depending on the degree of ptosis.
What is a patient with drooping eyelid like?
In adult patients with eyelid ptosis , there are two main consequences. First, the aesthetic alteration it produces, and second, the loss of the upper visual field (visor effect). When ptosis is bilateral (in both eyes) and appears slowly, it may go unnoticed by the patient for a long time, but when it is unilateral, it is very noticeable, no matter how mild the condition.
In childhood, a drooping eyelid can lead to lazy eye (amblyopia), as the eye does not receive enough visual stimulation to develop vision normally.
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In adults, it usually develops progressively, and the most common cause is the progressive stretching of the levator palpebrae muscle that occurs with age. The eyelid loses its anchor to the muscle, and the muscle is unable to raise it to an adequate height.
Congenital ptosis (present from birth) is usually due to an abnormality in the embryonic development of the levator muscle. That is, the muscle fibers have not developed normally and are replaced by fibrous tissue. The degree of muscle involvement in these cases varies greatly.
There are other less common causes of droopy eyelids: allergic reactions, muscle diseases, neurological diseases, and trauma.
In those rare cases where eyelid ptosis appears rapidly in days or a few weeks without a history of trauma, we must perform cranial imaging tests such as an MRI to rule out serious pathologies such as aneurysms or intracranial tumors.
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The treatment for droopy eyelids or palpebral ptosis is surgical, and there are different techniques depending on the type of patient. In any case, eyelid surgery is always performed on an outpatient basis with local anesthesia and sedation in adults.
There are different surgical techniques for treating a droopy eyelid , and they can be divided according to the approach:
- Anterior approach (through the skin): This involves reinforcing the main levator muscle through an incision in the natural fold of the eyelid, so the incision will be imperceptible. It is the same incision made for a blepharoplasty and they can be done together.
- Transconjunctival route (Putterman technique): This consists of strengthening the levator muscle via a transconjunctival route. That is, no skin incision is made so there is no scar.
- Frontal Suspension: In some cases of muscular diseases or congenital ptosis, the levator muscle of the eyelid is degenerated and the previous techniques are of no use. Front suspension is the technique of choice in these cases. It consists of connecting the eyelid to the frontal muscle, so that the patient can open their eyes by raising their eyebrows through the action of the frontal muscle.
To determine which technique is most appropriate for each patient, a thorough examination must be performed in consultation.
In children, treatment is usually delayed if ptosis is mild and there is no risk of lazy eye (amblyopia). If ptosis is more pronounced and there is a risk of amblyopia, early intervention is necessary. In children, the intervention is performed under general anesthesia.
The postoperative period is very similar to that of an upper blepharoplasty . The patient usually leaves with their eyes uncovered, and the only thing to expect during the following days is swelling and minor bruising, which disappears within 5 to 14 days, depending on the patient. It is important to apply cold the first few days to shorten the process. We also recommend lubricating the eyes with lubricating eye drops and applying an ointment to the stitches, which are removed after a week.
In cases of transconjunctival surgery, recovery is even faster. Bruising, if present, is minimal, and recovery is virtually complete within 10 days.
Some patients have little fat and are not good candidates for this technique, and others have very pronounced bags and need fat removal. The individualized examination determines which technique is best in each case.
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The way to treat and correct a droopy eyelid is by targeting that muscle. One of the most effective ways to lift a droopy eyelid is through isolated transconjunctival surgery. Eyelid surgery is always performed under local anesthesia and sedation and also offers a quick and painless recovery process.
There are three treatments for droopy eyelids: anterior approach (through the skin), transconjunctival approach, or frontal suspension.
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To alleviate the effects of droopy eyelids, a suitable option is to apply apraclonidine eye drops and a small dose of Botox to achieve a smooth, natural appearance. Botox’s function is to relax the eyelid muscles, making it a widely used and effective treatment for facial rejuvenation.
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Having one eyelid droopier than the other can be a symptom of eyelid ptosis . It occurs when the eyelid loses its support from the muscle, and the latter cannot raise it to the proper height.
The causes of eyelid ptosis are diverse, but the most common are allergies, muscle diseases, neurological diseases, and trauma.
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Droopy eyelids are usually due to a variation or alteration in embryonic development or other causes such as allergies, muscular or neurological diseases.
