Ptosis & Congenital Ptosis: Meaning, Causes & Symptoms

March 6, 2023

Ptosis means drooping. When you see people with one or both upper eyelids drooping, they might seem like they just rolled out of bed, but they are actually not. They suffer from a condition called upper eyelid ptosis or blepharoptosis

Ptosis will not significantly affect one’s health. The eyelid drooping may partially or fully cover the pupil resulting in blurry or double vision. In the worst scenarios, it can completely impair eyesight. But most of the time, ptosis hardly poses major impacts on day-to-day activities. More obviously is that it affects your appearance.

How Does Ptosis Happen?

Children and adults can both suffer from ptosis and there are several reasons that lead to the causes of ptosis based on the age group.

Ptosis In Children

Children who have drooping eyelids are usually present from birth due to family history and it is described as congenital ptosis. They will have a hard time lifting either one or both eyelids due to their levator muscle — a triangular-shaped muscle to lift the eyelid — is not strong enough to do so.

You can indicate a child with congenital ptosis when their upper eyelid creases do not line up uniformly with each other. Since the eyelid is covering parts of their pupil, they may tip their head back, lift their chin, or raise their eyebrows in an effort to see better. These movements may eventually lead to neck and head issues.

If left untreated, congenital ptosis can lead to amblyopia or “lazy eye,” which can cause one eye to have better vision than the other or permanent vision impairment.

Ptosis In Adults

Aging usually is the reason for the development of ptosis when the muscles or ligaments that help lift the eyelid are compromised by diseases, tumors, or injuries later in life.

A complication of Botox injections, neurological conditions, and eye trauma are some of the situations that lead to ptosis. While sometimes, the damage to the nerves that control the eyelid muscles can occasionally cause the eyelids to droop. 

Ptosis in adults can occasionally develop as a side effect following specific eye surgeries as well. The instruments used to keep the eye open during surgery can stretch the eyelid and it accelerates this occurrence.

Symptoms of Ptosis

The drooping eyelids are the most noticeable symptoms of ptosis and its severity varies from person to person. You may notice them raise their eyebrows, tilt their head back in an attempt to see clearly, and the compromised eye will also seem smaller than usual.

And ptosis caused by underlying medical conditions may show additional symptoms related to that illness.

Diagnosis & Treatments

The ophthalmologist will do a thorough eye examination to evaluate your overall eye health. Your eyelids will be closely examined by measuring the height and strength of your eyelid’s muscle to diagnose ptosis.

The doctor will also run a computerized visual field test to see the quality of your eyesight and assess whether ptosis is having an impact on it. You must maintain eye contact while viewing a series of flashing lights during the visual field test.

But if they suspect that your underlying medical conditions may be causing your symptoms, the doctor may order blood work or refer you to a neurologist in order to rule out the condition of ptosis.

The type of ptosis will be determined based on your medical history and the results from the comprehensive eye exams that have been carried out. Then, an oculoplastic specialist — the ophthalmologist with advanced training in plastic surgery of the eyes — may be referred to you. They can assist in deciding which surgery is the best option for you based on the diagnosis and severity of the ptosis.

So, how does a drooping eyelid be treated?

Treatment for children

When determining the ideal course of treatment for ptosis in children, ophthalmologists will take several criteria into account. That includes the children’s age, whether one or both eyelids are affected, the height of the eyelid, the strength of the eyelid’s muscles, and eye movements.

The most common treatment options for children include

  1. Eyeglasses or contact lenses: Any vision issues that might be contributing to the ptosis can be fixed with these.
  2. Eyelid surgery: In order to lift the drooping eyelid, this involves surgically tightening or relocating the muscles that control the eyelid. This procedure is called blepharoplasty.
  3. Botulinum toxin (Botox) injections: These can be used to temporarily paralyze the eyelid-controlling muscles, which will aid in lifting the drooping eyelid.
  4. Eye drops or ointments: These can be used to enhance eye lubrication, helping in the reduction of dryness and irritation that might be causing the ptosis.

In most cases, ophthalmologists usually advise surgery to treat children with ptosis. In order to lift the eyelid, either the levator muscle has to be tightened or the eyelid needs to be connected to other muscles. The objective is to enhance eyesight.

The child’s amblyopia — if present — has to be addressed as well because their eyes change shape as they grow up. Amblyopia can be treated by strengthening the weaker eye by using specific eye drops, wearing an eye patch or special glasses, or both.

Treatment For Adults

Adults will develop ptosis when the levator muscle stretches or separates from the eyelid — which is caused by eye injuries or aging. Ptosis can also occasionally develop as a side effect following specific eye surgeries.

The most common treatment options for adults include

  1. Eyeglasses or contact lenses: These can be used to correct any vision issues that may be causing the ptosis.
  2. Eyelid surgery: This involves surgically tightening or repositioning the muscles that control the eyelid to lift the drooping eyelid.
  3. Botulinum toxin (Botox) injections: These can be used to temporarily paralyze the muscles that control the eyelid, helping to lift the drooping eyelid.
  4. Eye drops: For adults with acquired ptosis, a new prescription eye drop medication called oxymetazoline can be prescribed that will target the eyelid-raising muscle. After taking the drops, the eyelid may open wider. Make sure to use it daily. However, certain types of droopy eyelids — such as those brought on by injury or nerve issues — cannot be treated with oxymetazoline.
  5. Artificial eyelid weights: These small weights are placed inside the eyelid to help lift the drooping eyelid.
  6. Prism glasses: If the ptosis is caused by double vision, prism glasses can be prescribed to remedy the double vision.

All ptosis surgeries are performed as outpatient treatment, allowing patients to leave the hospital and return home the same day. The eye and the area around it will be numbed with a local anesthetic.

Final Say

The meaning of ptosis may be influenced by its underlying cause, as some forms of the condition can be a symptom of a neurological disorder or muscle weakness. If you suffer from drooping eyes and wish to remedy the condition while also recovering your appearance, consult an eye doctor at VISTA Eye Specialist. You will be evaluated comprehensively by our highly qualified doctors in order to find the causes of your ptosis and treat it effectively with the best course of treatment.


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