What is Droopy Eyelid?

Drooping eyelid (palpebral ptosis) is a descent of the upper eyelid that causes it to cover the eye more than normal. The patient has difficulty opening the eyes normally, which often causes fatigue at the end of the day and can make vision difficult depending on the degree of ptosis.

Droopy Eyelid Drawing
Ptosis: Schematic representation of a normal eyelid and a drooping eyelid, in which the distance between the eyelid and the pupil is reduced.

In palpebral ptosis, the adult patient has two main consequences. On the one hand the aesthetic alteration that it produces, and on the other hand the loss of superior visual field (visor effect). When ptosis is bilateral (from both eyes) and appears slowly it can go unnoticed by the patient for a long time, but when it is unilateral it is very noticeable however slight.

In children’s age, a drooping eyelid can result in a lazy eye (amblyopia), since the eye does not receive enough visual stimulation to develop vision normally.

Causes of Palpebral Ptosis (droopy eyelid)

Example of a droopy eyelid
Ptosis 2: In a real patient, before and after a correction of her droopy eyelid without blepharoplasty, as this patient presents only a descent of the eyelid without excess skin.

In adults it usually appears progressively and the most frequent cause is the progressive stretching of the eyelid lift muscle that occurs with age. The eyelid loses its anchorage with the muscle and the muscle is unable to raise it to an adequate height.

Congenital (from birth) ptosis is usually due to an alteration 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 frequent causes of droopy eyelids: allergic reactions, muscle diseases, neurological diseases and trauma.

In those rare cases in which a palpebral 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.

Treatment of Palpebral Ptosis

The treatment of palpebral ptosis is surgical, and there are different techniques according to 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 to treat palperal ptosis and we can divide them according to the approach:

  • Anterior route(by skin): It consists of reinforcing the main elevator muscle through an incision in the natural fold of the eyelid, so the incision will be imperceptible. This is the same incision made for a blepharoplasty and can be done together.
  • Transconjunctival pathway (Putterman technique): Consists of strengthening the lift muscle by transconjunctival pathway. That is, no skin incision is made so there is no scar.
  • Frontal Suspension: In some cases of muscle disease or congenital ptosis the eyelid lift muscle is degenerated and the above techniques do not work. The 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 his eyes by raising the eyebrows by the action of the frontal muscle.

In order to determine which technique is the most suitable for each patient, a thorough examination must be carried out in consultation.
In childs, treatment is usually delayed if the ptosis is mild and there is no risk of lazy eye (amblyopia). If ptosis is more pronounced and there is a risk of amblyopia, surgery should be performed soon. In children the intervention is performed under general anesthesia.

The post-operative period is very similar to that of an upper blepharoplasty. The patient usually leaves with his eyes uncovered and the only thing that can be expected during the following days is swelling and small bruises, which disappear between 5 and 14 days depending on the patient. It is important to apply cold the first few days to shorten the process. We also recommend eye lubrication with lubricating eye drops and the application of an ointment on the stitches, which are removed every week.

In cases of transconjunctival surgery, recovery is even faster. Hematomas, if they appear, are minimal, and in 10 days recovery is practically complete.

Some patients have little fat and are not good candidates for this technique, and others are have very pronounced pockets and need fat removal. The individual examination determines which technique is best in each case.

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