Ptosis Surgery | Droopy Eyelid Surgery By Dr. Claudine Pang

What is ptosis?

Ptosis, or droopy eyelids, refers to a pathological drooping of the eyelids. It is a medical condition that not only affects our appearance, but also causes discomfort due to lid heaviness and visual obstruction.

What causes ptosis?

It is possible for ptosis to be present at birth (congenital ptosis), and it is also possible for persons with normal eyelids to acquire ptosis through a variety of causes. These include: 

• Age

As we age, the muscles that support our eyelids weaken, causing our eyelids to droop. Most ptosis cases are age-related. 

• Trauma

Trauma or injury to the eye can weaken or damage the levator aponeurosis, the muscle that lifts the eye. Consequently, this damage can result in upper eyelid drooping. 

• Injury

On the off chance that only one of your eyelids experiences drooping, it might be an aftereffect of a nerve injury or a stye. Routine LASIK or cataract surgery can occasionally result in ptosis due to the levator muscle or tendons in the area getting stretched from the procedure.

• Long term contact lens use 

Prolonged stretching of the eyelid can cause the eyelid to stretch over time. This stretching causes the eyelid to fall lower, and in some cases, obstruct the person’s ability to see properly.

• Medical conditions 

Ptosis may be a sign of an underlying medical condition, especially if both eyelids droop. These conditions may include a stroke, tumours of the brain, or malignant cancers of the nerves or muscles.

What are the symptoms of droopy eyelids?

Often, patients with droopy eyelids are unaware they have the condition as their ptosis might not be severe enough to present an obvious change in physical appearance. 

They usually present with these symptoms: 

• Very dry or watery eyes
• May also appear exhausted or listless
• Pain or discomfort around the eyes 
• Some patients with advanced ptosis may even need to tilt their heads back to see their counterpart when holding a conversation.

Who is at risk of developing ptosis/droopy eyelids?

There are several causes of droopy eyelids, varying from natural causes to more serious health conditions; as such, anyone can be at risk of developing this condition. 

However, ptosis is most common in older adults due to the ageing process, where the eyelid muscles responsible for opening the upper eyelid stretch over time. 

That said, it should be known that persons of every age can develop ptosis. There is also no bias between ethnicity or gender.

Ptosis in Children

The most widely recognized reason for congenital ptosis is improper development of the levator muscle. Kids who are born with ptosis are likely to also suffer from amblyopia, or ‘lazy eye’. This condition may affect the visual ability of the affected children.

How is ptosis diagnosed?

Your eye specialist will measure the distance between your upper eyelid margin and corneal light reflex, also known as the margin reflex distance (MRD). A margin reflex distance of 2mm and above qualifies as ptosis. 

During consultation, your eye specialist will also check for underlying health abnormalities or pre-existing conditions. This is particularly significant if you complain of headaches, migraines or different symptoms that have appeared since the drooping of eyelids was first observed.

Ptosis Surgery 

Treatment of ptosis is not always cosmetic and often medically necessary to relieve visual obstruction. The method of treatment for the droopy eyelid, however, would depend on the specific cause and the severity of the ptosis.

In the event that the condition is the consequence of the normal ageing process, or if it was a congenital case, your eye specialist may state that the condition is not damaging to your health. In such cases, there may be no need, except for aesthetic reasons to correct the droopy eyelid(s). Plastic surgery is then an option here to reduce the drooping eyelid(s).

In the event that your eye specialist finds that your ptosis is brought about by an underlying medical condition, the priority here would then be to first treat the condition that first brought about ptosis in the first place. With the condition under control, the drooping will typically cease at that point.

Should your case of ptosis cause an obstruction to normal vision, surgery may then be required to correct the drooping eyelid, and to restore your visual ability.

Ptosis Surgery by Dr. Claudine Pang

Ptosis surgery at Asia Retina is carried out by Dr. Claudine Pang, Medical Director and ophthalmologist with over 15 years of experience. While droopy eyelids can be corrected with a plastic surgeon, an ophthalmologist can: 

• Perform a comprehensive eye exam to assess your eye health 
• Perform a visual field test to assess your superior vision
• Determine if ptosis is affecting your vision 
• Examine your pupils for weakness (especially important for those with ptosis caused by nerve weakness)
• Examine the strength of your levator muscle 

What are the risks of ptosis surgery? 

This procedure involves the tightening of the levator muscle. The result is a ‘lifting’ of the previously drooping eyelid. For congenital ptosis cases, the eye specialist may suggest for the child to prevent the development of ‘lazy eye’ in the future.

Risks of surgery include dry eye, scratched corneas, and/or hematomas. Human error is also a risk to be considered – an inexperienced surgeon can ‘over-correct’ or ‘under-correct’ ptosis, leaving the eyelid hanging too high, or low.

As such, it is in your best interest to pick an experienced eye surgeon in Singapore.

Frequently Asked Questions