Ptosis is the term for droopy, sagging eyelids. There are several causes of ptosis including age, injury, muscle or nerve disorders, and congenital defects. Droopy or baggy eyelids not only can falsely portray an aged or tired appearance, but often times it can affect vision. Patients may complain of visual obstruction superiorly, fatigue with reading, or brow ache from lifting the forehead muscles to compensate for the heavy, drooping eyelids. In these instances, blepharoplasty or ptosis surgery is considered medically necessary and is usually covered by insurance. When blepharoplasty of the upper or lower eyelids is performed to improve one’s appearance in the absence of any signs or symptoms of functional abnormalities, the procedure is considered cosmetic. (Refer to the link on cosmetic Blepharoplasty).

Since there are many causes of ptosis, it is important to undergo evaluation by a qualified physician who can properly evaluate and treat a patient with ptosis. Ptosis occurs when the upper eyelid droops from lack of normal eyelid support. Children with ptosis can be a serious condition as a drooping eyelid can interfere with visual development. The majority of patients develop ptosis due to aging changes, which includes stretching or detachment of the eyelid muscle responsible for elevating the upper eyelids. Dermatochalasis can cause a “secondary” ptosis, with excess skin or tissue resting on the upper eyelid causing the eyelid to droop. Heavy or drooping eyebrows can also cause a "secondary" ptosis. Ptosis is also associated with trauma, prior ocular surgery, conditions such as thyroid disease, blepharospasm, nerve palsies or progressive neuromuscular conditions such as myasthenia gravis.

Patients undergo evaluation by the surgeon, photographs and a visual field test to demonstrate the degree of visual field defect before surgery. Surgery is usually necessary to correct eyelid ptosis, and is performed on an outpatient basis. Eyelid ptosis repair is aimed at tightening the weakened or slipped muscle in most cases. For severe ptosis, a suspension material to attach the eyelid to the forehead may be necessary so the forehead muscle can lift the weakened eyelid. When excess upper lid skin or heavy brows are the culprit, patients may need a blepharoplasty or brow lift. Brow lifting for visual improvement often involves an incision just above the brows. Visit www.asoprs.org for more information.

Congenital ptosis occurs as a result of a poorly developed muscle in the upper eyelid. It is important to be evaluated at a young age for congenital ptosis as the droopy eyelid could cause poor visual development and treatment may be required. Often the child learns to adapt with tilting his or her head up to see, and sometimes patching the non ptotic eye can be useful. Oftentimes, surgical repair requires a sling from the eyelid to the frontalis or forehead muscle, and the child learns to use the forehead muscles to lift the eyelid. Children often require more than one eyelid procedure in their lifetime.