Ptosis- droopy eyelids

Visible drooping of one or both upper eyelids.

Eye fatigue, especially with sustained visual tasks.

Brow ache from compensatory eyebrow raising.

Head tilt or chin lift to improve vision.

Dry or watery eyes.

Altered facial expression (tired appearance).

Diagnosis includes:

• Clinical examination to assess eyelid height, contour, and muscle function.
• Medical history to identify potential underlying causes.
• Comprehensive eye assessment, which may include:
  • Slit-lamp examination
  • Visual field testing
  • Eye movement evaluation
• Further tests when indicated:
  • Imaging (CT/MRI) to assess structural or neurological causes
  • Blood tests for systemic disorders (e.g., myasthenia gravis)

• Developmental muscle abnormalities
• Age-related levator dehiscence
• Trauma or previous surgery
• Neurological conditions
• Systemic neuromuscular diseases

1. Surgical Management

Surgery is the most definitive treatment when ptosis affects vision or appearance.

Techniques include:

• Levator advancement or resection: Tightening the levator muscle or tendon.
• Posterior approach: Adjustment from the underside of the eyelid, leaving no visible scar.
• Frontalis sling: Used when the levator muscle is very weak; links the eyelid to the forehead muscle.

Combined procedures (when appropriate):

• Upper eyelid blepharoplasty (to reduce excess skin)
• Brow lift (to improve brow/eyelid position)

2. Non-Surgical Options

• Ptosis props/crutches: Devices attached to glasses to hold the eyelid open.
• Prescription eye drops (e.g., oxymetazoline): Provide temporary lifting by stimulating Müller’s muscle.

• Improved visual field
• Relief from brow strain and fatigue
• More symmetrical and rejuvenated appearance
• Enhanced comfort during daily tasks

• Mild swelling and bruising for several days
• Eye protection and prescribed drops immediately after surgery
• Follow-up assessments to ensure appropriate healing

Most individuals resume normal activities within approximately a week, although complete healing may take a few weeks.

Every surgical treatment has some risk. However, you can be sure you are in competent and safe hands with us. We will go over any potential issues and side effects during your appointment with us. Following your ptosis surgery, you should anticipate a few common symptoms, which often go away in a few days. Some of them include:

Infection: This is rare; stitches may become infected or inflamed. This can be swiftly settled with oral and topical antibiotics.

Scarring: Generally, scars are hidden in the skin fold. Stitches are normally visible for the first week, and when they are removed, a faint scar is visible. While the scar may seem thickened and red for 6 to 12 weeks, it will gradually become almost invisible after that period. While not every scar heals equally well, silicone scar remodelling gel can improve the appearance of a thickened or reddened scar. However, the treatment needs to be continued for several months to have a good result.

Large bruise or haematoma: This can be minimised by using ice packs, avoiding heavy exercise for 2 weeks after surgery, and stopping aspirin and other anticoagulants 2 weeks pre-operatively. If you do experience a haematoma, you may have to go back to have the blood clot removed and your stitches redone.

Asymmetry of eyelid shape, height, upper lid fold, or fullness: This is rare but can occur. Often, asymmetry may be due to lid bruising and settles as the swelling resolves. Rarely, this may require revision surgery. Occasionally, pre-existing asymmetry of the face, eyebrow, or eyeball position may be responsible; however, your surgeon will discuss this with you prior to the operation.

Blood-stained tears: This can occur within the first 48-72 hours after surgery and should be managed by gentle, firm, and constant pressure on the shut eyelid for 10-15 minutes.

Recurrence of ptosis: This can occur early or late after surgery due to suture dissolution, stretching, or scar weakening. It will need to be corrected by reoperation.

Contralateral ptosis: The position of one droopy eyelid can make the other appear normal. However, immediately after surgery, the “normal” eyelid can droop. This can correct itself within a few weeks or require a ptosis correction.

Exposed stitches causing discomfort or a pricking sensation: If this happens, the offending stitch must be removed. Rarely, if the stitch is not removed, it can cause a corneal ulcer, requiring intensive topical antibiotic treatment.