An eye doctor will diagnose ptosis by carefully examining the eyelids. He or she will take detailed measurements of the height of the eyelids and will assess the strength of the eyelid muscles.
Surgery can be an effective treatment for ptosis in both children and adult, improving vision as well as cosmetic appearance. It is very important that children with ptosis have regular ophthalmic examinations early in life to monitor their vision and prevent severe vision loss from untreated amblyopia.
Congenital ptosis treatment
In most cases, the treatment for childhood ptosis is surgery. If amblyopia is present, treatment with patching, eyeglasses, or eyedrops may be necessary. In determining whether or not surgery is necessary and which procedure is the most appropriate, an ophthalmologist will consider a few important factors:
- The child's age;
- Whether one or both eyelids are involved;
- The eyelid height;
- The eyelid's lifting and closing muscle strength;
- The eye's movements.
During ptosis surgery, eyelid-lifting muscle (levator) is tightened. In severe ptosis, when the levator muscle is extremely weak, the lid can be attached or suspended from under the eyebrow so that the forehead muscles can do the lifting.
Mild or moderate ptosis usually does not require surgery early in life. Children with ptosis, whether they have had surgery or not, should be examined regularly by an ophthalmologist for amblyopia, refractive disorders and associated conditions. Even after surgery, focusing problems can develop as the eyes grow and change shape.
Adult ptosis treatment
Your ophthalmologist will determine the cause of the ptosis and plan the best treatment. If treatment is necessary, it is usually surgical. Sometimes a small tuck in the lifting muscle and removal of excess eyelid skin (called blepharoplasty) can raise the lid sufficiently. More severe ptosis requires reattachment and strengthening of the levator muscle.
What are the risks of ptosis surgery?
The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications are not common. Immediately after surgery, you may find it difficult to completely close your eye, but this is only temporary. Lubricating eyedrops and ointment can be helpful during this period.
Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation may be required.
Additional ptosis information resources
American Academy of Ophthalmology Preferred Practice Pattern: Pediatric Eye Evaluations (2012)
American Academy of Ophthalmology Preferred Practice Pattern: Comprehensive
Adult Medical Eye Evaluation (2015) (PDF)