Do your eyelids droop? Let's talk about Ptosis (drooping eyelids)!

Have you ever noticed that some people's upper eyelids droop a little, making them look sleepy? Or that some babies have one eyelid drooping lower than the other? That's what we call `Ptosis` in medical terms, or simply drooping or drooping of the eyelid. While this may be a minor problem for some, for others it can affect their vision. So let's talk about this in a little more detail today, shall we?

What is ptosis? Simply put...

Simply put, `Ptosis` is when your upper eyelid falls below its normal level and falls on your eye. This happens because the `levator muscle`, which helps to keep the eyelid up, is not working properly. Think of it like a window latch, which holds the eyelid up. If it becomes weak, the eyelid will fall down. Depending on how far the eyelid falls, your vision can be limited or completely blocked. Sometimes only one eye can see this condition, other times it can affect both eyes. One eye can be affected more than the other. Doctors also call it `blepharoptosis`. But when we talk about `ptosis` or `drowsiness of the eyelid, everyone understands.

What are the types of drooping eyelids?

This condition of `Ptosis` can affect both young children and adults. There are two main types:

1. Congenital ptosis

What happens in this case is that your baby is born with this condition. This means that this happens because of some problem with the development of the previously mentioned `levator muscle` while the baby is in the womb.

2. Acquired ptosis

This type of blepharitis occurs in adults later in life. What happens here is that the levator muscle weakens over time, or separates from the eyelid.

What are the symptoms of this condition? See if you have any...

This can usually be identified by looking at the eyelid. The eyelid may be slightly drooping over the eye, or it may be completely closed. In addition, you may see the following symptoms:

• Constantly rubbing your eyes.
• Increased tearing from the eyes.
• Decreased vision or blurred vision.
• Feeling tired and sore around the eyes.
• Young children, for example, will tilt their necks back and look up (this is a very important characteristic, as they do this because they cannot see properly due to their eyelids).

Imagine how uncomfortable it would be if you had to constantly crane your neck to see clearly? For a small child, this can affect everything from daily tasks to playing and learning.

Why do eyelids droop like this? What are the causes?

There are several things that can cause this, and it also varies depending on the type of `Ptosis`.

• Congenital ptosis: As mentioned earlier, this occurs due to a problem with the development of the levator muscle at birth.

• Acquired ptosis:
• Aging : This is the most common cause. As we age, our eyelids, along with the muscles and ligaments in them, become stretched and weakened.
• Eye injuries: If an accident causes damage to the eyelid.
• Eye surgery : Sometimes this condition can also be caused by previous eye surgery. This is because the instruments used to keep the eye open during surgery can pull on the eyelid.
• Nerve disorders : Damage to the nerves that control the eyelids.
• Some medical conditions:
• Stye​
• Horner syndrome
• Myasthenia gravis - This is a disease that weakens the muscles.
• ` Stroke`
• Eye tumor
• `External ophthalmoplegia`

What happens if it's not treated? Shouldn't it just be left alone?

This is a very important matter.

• If your little one has congenital ptosis, it's best to treat it as soon as possible. If left untreated, it can affect the child's vision development and cause other side effects .
• Mild acquired ptosis in adults may not require treatment unless it significantly affects vision.
• However, if eyelid drooping is severe, it can lead to serious complications if left untreated.

What are these complications?

• Astigmatism: The drooping eyelid puts pressure on the front part of the eye (cornea), which can cause the shape of the eye to change. This can cause vision to appear distorted (stretched, wrinkled).
• Amblyopia (or "lazy eye"):Vision defects like astigmatism can cause amblyopia, which is like the eye that is not being used becoming "lazy".
• "Chin-up position": Especially young children, they often turn their necks up to look under their drooping eyelids. This can lead to neck problems, tight forehead muscles, and developmental delays.

How do doctors detect this?

A doctor can usually tell if you have ptosis by looking at your eyelids. It can be difficult to tell if both eyes are affected. The doctor will examine you. Then, they may refer you to an ophthalmologist. He or she will examine your eyes and may do other tests if necessary.

What tests are performed?

The ophthalmologist may perform tests such as:

• Slit lamp examination: A test in which the eye is magnified with a special lens .
• Visual field testing: This tests how far you can see.
• Ocular motility (eye movement) test: Checks whether the eyes move back and forth properly.
• Tensilon test: This is done to find out if you have a disease called `Myasthenia gravis`. This test is done by giving a medicine called `Tensilon` or `edrophonium`.

How is this treated?

The treatment for ptosis usually depends on how well your eyelid muscles are working. If it doesn't affect your vision and you don't mind the way it looks, you may not need treatment. However, if ptosis is causing problems with your vision, appearance, or both, your eye doctor will recommend treatment. The type of treatment depends on whether the ptosis is caused by a medical condition or aging. Ptosis caused by aging usually requires surgery.

Eyelid surgery (Ptosis surgery)

This surgery is usually done under local anesthesia with sedation. This means that you are conscious, but the area where the surgery is performed is numb, so you do not feel any pain. There are several types of eyelid lift surgery: 1. First method: The surgeon makes a small incision in the skin of your upper eyelid. This allows you to find the small muscle that lifts the eyelid. Then, the muscle is tightened and stitches are placed to lift the eyelid. Finally, the incision made in the eyelid skin is closed with more stitches. 2. Second method: In this case, the surgeon can perform the entire surgery from under the eyelid. Then, the eyelid is rolled up and the muscle underneath is tightened. This method does not require a skin incision. After the surgery, the doctor will give you instructions on how to care for your eye.It is very important to see your doctor after surgery to check the results. You will usually be asked to come back a few days or a week after surgery.

Possible complications after surgery

Some complications may occur after surgery. But don't worry, these are usually temporary.

• Soon after surgery, the height and shape of the eyelids may become asymmetrical on both sides.
• It is possible that the doctor has overcorrected or undercorrected the eyelid. These will correct themselves over time.
• Other complications:
• Bleeding from the wound.
• Infections at the surgical site.
• Damage to the transparent front part of the eye (the cornea).
• The eyelid fails to close completely or properly.
• Recurrence of `Ptosis`.

Eye drops for ptosis

There is now a prescription eye drop that can be used to treat some types of `acquired ptosis` in adults. This medicine is called `oxymetazoline` . It works directly on the `levator muscle`. After using these drops, some people have found that their eyelids open better. However, for this to continue to work, these drops must be used every day. These drops do not work for all types of `ptosis`. Therefore, you should talk to your ophthalmologist to find out if this is right for you.

Can this be prevented?

• Congenital ptosis cannot be prevented, as it is present at birth .
• Many of the factors that cause acquired ptosis are difficult to prevent.

What should I expect if I have this condition? (Prognosis)

The prognosis for ptosis depends on the type and severity of the condition. If you need surgery, the results are usually good. Most surgeries to correct drooping eyelids are very successful.

When should I see a doctor?

You should see your eye specialist in the following cases:

• If your vision is affected by `ptosis`.
• If this condition affects your appearance and it bothers you,
• If one eyelid suddenly starts to droop or close.
• If you see double vision or have pain.

Most importantly: If your young child has `Ptosis`, take him to an eye specialist immediately for an evaluation. The doctor may recommend starting treatment early to prevent vision problems. Whether treatment is started early or later, it is important to have regular eye exams to monitor your child's vision.

What questions should you ask the doctor?

When you go to see the doctor, don't forget to ask these questions:

• How did I get `Ptosis`?
• How bad is my condition?
• Do I need treatment? What kind of treatment do you recommend?
• Do I need surgery?
• What are the possible complications of surgery?
• Can `Ptosis` recur?

Final Take-Home Message

If you or your child is having trouble seeing with one or both eyes, take a look at your eyelids. Are they drooping? `Ptosis` can be a very annoying condition, especially if you have to constantly turn your head to look up. You don't have to live with this discomfort. In fact, it's not good to live with it. If left untreated, this condition can lead to complications like `Astigmatism` and `Amblyopia`. So, see your eye doctor today to talk about it. Your vision is precious, and it's your responsibility to protect it.