Ptosis is when the upper eyelid droops over the eye. The eyelid may droop just a little, or so much that it covers the pupil (the black dot at the center of your eye that lets light in). Ptosis can limit or even completely block normal vision.
Children and adults can have ptosis. Fortunately, this condition can be treated to improve vision as well as appearance.
Ptosis in children
Children born with ptosis have what is called congenital ptosis. This can be caused by problems with the muscle that lifts the eyelid (called the levator muscle).
The most obvious sign of ptosis is a drooping eyelid. Another sign is when the upper eyelid creases do not line up evenly with each other. A child with ptosis may tip their head back, lift up their chin, or raise their eyebrows to try to see better. Over time, these movements can cause head and neck problems.
Sometimes, a child born with ptosis can also have other eye-related problems. They can include eye movement issues, eye muscle disease, tumors (on the eyelid or elsewhere) and other problems.
Having ptosis puts a child at risk for vision problems. If the child’s eyelid droops so much that it blocks vision, amblyopia (also called “lazy eye”) can develop. One eye will have better vision than the other. A child with ptosis can also have astigmatism, where they see blurry images. The child may also develop misaligned (crossed) eyes.
Ptosis in adults
Adults get ptosis (called involutional or acquired ptosis) when the levator muscle stretches or separates away from their eyelid. This can be caused by aging or an eye injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.
Your ophthalmologist will find the cause of your ptosis in order to recommend treatment. They will do a complete eye exam, and may also want you to have blood tests and imaging tests. The ophthalmologist will likely recommend surgery to help the eyelid muscle work better.
Ptosis treatment for children
Ophthalmologists consider the following factors when deciding the best way to treat ptosis in children:
- The child’s age
- Whether one or both eyelids are involved
- The eyelid height
- The strength of the eyelid’s muscle
- The eye’s movements
In most cases, ophthalmologists recommend surgery to treat ptosis in children. This is to either tighten the levator muscle or attach the eyelid to other muscles that can help lift the eyelid. The goal is to improve vision.
If the child also has amblyopia, that condition must be treated as well. Amblyopia may be treated by wearing an eye patch or special eyeglasses, or using certain eye drops, to strengthen the weaker eye.
All children with ptosis—whether or not they have surgery—should see their ophthalmologist regularly for eye exams. Ask your child’s ophthalmologist how often exams are needed. Because kids’ eyes grow and change shape, they need to be checked for amblyopia, refractive disorders, and other eye problems.
Medication for adult ptosis
There is a new prescription eye drop for some adults with acquired ptosis. The medication—oxymetazoline— targets the muscle that raises the eyelid. In some people with acquired ptosis, the eyelid opens wider after using the drops. It needs to be used every day to keep working.
Oxymetazoline does not work for certain types of droopy eyelid, like those arising from injury or nerve problems. So ask your ophthalmologist if it is right for you.
Adult ptosis surgery
Ptosis surgery is usually done as an outpatient procedure, which means you can go home the same day as the surgery. A local anesthesia will be used to numb your eye and the area around it.
Sometimes, the surgeon may only need to make a small adjustment to the lid’s lifting muscle. For more severe ptosis, the levator muscle may need to be strengthened and reattached to the eyelid.
As with any type of surgery, there are possible risks and complications with ptosis repair. Your ophthalmologist will discuss these with you.
Before eyelid surgery, be sure to tell your ophthalmologist about all the medicines you take. Include all prescription and over-the-counter medications, vitamins, and supplements. It is important for your eye surgeon to know if you take aspirin (or aspirin-containing drugs) or blood thinners, or if you have a bleeding problem.