Cosmetic Medicine / Plastic Surgery Eye Health / Blindness

How do you treat a droopy eyelid?

Droopy eyelid or ptosis is when the upper eyelid droops downward. Doctors can treat a droopy eyelid with surgery, although this may depend on the cause. Reasons why an eyelid may droop include genetics or damage to the eye, and the condition is more likely with age.

Treatment may not be necessary in cases where there is no impact on vision. However, a droopy eyelid can cover the pupil and reduce vision in some cases.

Ptosis can be present at birth, but people can also acquire it later in life due to:

  • injury or stretching of eyelid muscles or ligaments
  • damage to the nerve controlling the eyelid muscles
  • aging
  • a complication of eye surgery
  • a complication of Botox injections

Ptosis does not lead to any health issues, in most cases, and is easily manageable.

Causes

Droopy eyelid
Some people may have droopy eyelids from birth.

Congenital ptosis is present from birth and may have genetic causes. It can affect one or both eyelids.

Congenital ptosis can impair vision and cause amblyopia, sometimes known as lazy eye.

In a 2013 study of 107 children with ptosis, researchers noted lazy eye in around 1 in 7 of the participants.

People can also acquire ptosis later in life.

A common cause is accidental stretching or tearing of the levator aponeurosis, which is a tendon-like sheathe that allows the eyelid to move.

Damage may occur from:

  • excessive eye rubbing
  • use of rigid contact lenses
  • eye surgery

The eyes and eyelids are delicate, and there are many other potential causes of acquired ptosis, including:

  • eyelid tumors, cysts, or swelling
  • Horner’s syndrome
  • muscular problems
  • nerve damage in the eye muscles
  • neurological conditions
  • eye trauma
  • Botox injections


Risk factors

Person with contact lenses
Wearing contact lenses can increase the risk of developing ptosis.

Potential risk factors for ptosis include:

  • age
  • contact lenses
  • excessive eye rubbing
  • eye surgery
  • Horner’s syndrome
  • myasthenia gravis

Prevention

It is hard to stop the development of ptosis, particularly if it is congenital. Acquired ptosis may have causes that are not preventable.

An example of acquired ptosis is when the natural aging processes weaken the eyelid muscles.

Other factors, such as eye trauma, surgery, or the development of muscular and nerve damage, can also be difficult to avoid.

A 2015 study from the Aesthetic Surgery Journal notes that there is no link to lifestyle factors including smoking, alcohol use, or body mass index.

Avoiding the use of contact lenses and excessive eye rubbing, however, can reduce the risk of acquired ptosis.

A 2016 paper, in the Journal of Clinical and Aesthetic Dermatology, notes that Botox injections, often by inexperienced injectors, are mostly connected to ptosis in aesthetic medicine.

Choosing a Botox injector with good experience will usually decrease the chances of eyelid ptosis when a person is receiving an injection for lines between the eyebrows.


Symptoms

A doctor can offer advise on treating a droopy eyelid.
A doctor can offer advise on treating a droopy eyelid.

The main symptom of ptosis is the droopy eyelid itself.

This droop is unnoticeable in many cases and does not cause pain. In other cases, a person may consider the condition has a negative impact on their appearance, and it may impact psychological well-being.

The eyelid may cover enough of the eye to impair vision in some cases, which may be worse when reading or looking downwards.

It can also cause the eyebrow to raise to compensate for the visual block, which can tire the muscles in the face.

Treatment

Treatment for ptosis will depend on its severity.

Ptosis rarely causes discomfort or other health issues, so treatment is often not required. Treatment may be desirable for cosmetic purposes or to fix visual impairments.

Surgery may be used to treat ptosis in specific cases. The aim of this surgery is typically to tighten the levator muscle or repair the levator aponeurosis, which can help raise the eyelid.

The procedure is safe, but complications are possible. In some cases, the surgery can undercorrect the problem.

Overcorrecting is also a potential complication. This leaves the eyelid either too high or too low and requires further surgery.

In a 2018 study, researchers examining revision rates for ptosis surgery among 1,519 patients found that 8.7 percent of cases required further surgery.

Treating eyelid ptosis caused by Botox injections can include stimulation of the muscle with the back of an electric toothbrush, application of eye drops, or merely allowing time to take its course, as this ptosis will usually correct itself in 3 to 4 weeks.


Takeaway

Ptosis is unlikely to have a significant impact on health. Ptosis is barely noticeable in most cases and does not have a major effect on daily life.

It may disrupt vision or have a more noticeable impact on appearance in other cases. Treatment, including surgery, is available in such cases.

It is not possible to cure ptosis unless the cause is a Botox injection, but treatment can easily manage the condition.

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