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Drooping eyelids

Dr. Ajay Mohan (AIIMS)MBBS

August 05, 2020

August 05, 2020

Drooping eyelids
Drooping eyelids

Drooping eyelids are medically called ptosis or blepharoptosis. In this condition, the border of the upper eyelid droops down to a position lower than normal. In severe cases of ptosis, the drooping eyelid covers either half or all of the pupil (the centre portion of the eye), thus interfering with vision.

Ptosis may be present at birth (congenital ptosis) or be acquired later in life. Congenital ptosis occurs due to an abnormality of the muscle which lifts the eyelid (the levator muscle). A person with a drooping eyelid may present with other symptoms like loss of the crease between the eyelid and eyebrow, bulging or puffiness of the eyes, dark circles or bags under the eyes, dry or watery eyes and vision problems.

Drooping eyelids can occur due to ageing, eye infections, eye tumours, peripheral nerve damage, brain aneurysm, thyroid dysfunction, diabetes, neuromuscular diseases like myasthenia gravis and oculopharyngeal muscular dystrophy. Sudden drooping of the eye can indicate stroke which can be life-threatening if not treated on time.

Usually, ptosis is not treated if it does not give any trouble to the patient. The treatment is done when the drooping eyelid either blocks your vision or affects your appearance. The treatment involves correction of the problem by surgically raising the drooping eyelid.

For babies born with severe congenital ptosis, the doctor performs prompt corrective surgery to prevent permanent vision damage. Children with mild ptosis without impaired vision are either treated with surgery or non-surgical measures such as botox and fillers. Other treatments are done according to the underlying conditions.

(Read more: Vision problems in babies)

Symptoms of drooping eyelids

You can self-diagnose the condition by looking directly into the mirror. A person with ptosis would present with narrow eye-opening, which makes the eye look smaller than normal. Some other symptoms which may be present along with drooping of the eyelid include:

  • Loss of the crease between upper eyelid and eyebrow
  • Unconscious raising of the eyebrow of the drooping eyelid
  • Presence of extra skin on the lower eyelids leading to bulging or puffiness
  • Obstruction of vision due to hanging of the upper eyelid
  • Either dry eyes or watery eyes
  • Titling the head back in order to see better

You may need to contact your doctor if any of the following symptoms start to appear:

  • Sudden drooping of the eyelids
  • Drooping eyelids hindering the vision
  • Pain in the affected eye
  • Swelling extending beyond the margins of the lid
  • Eyes unable to close completely while sleeping
  • Eyelashes start poking the eyeball

Causes of drooping eyelids

The causes of drooping eyelids are:

  • Congenital defect: A child can be born with a drooping eyelid, which is medically called congenital ptosis. Drooping can be seen either in one or both the eyelids. Though it can be due to an unidentifiable cause, sometimes it may be an indication of an underlying medical condition such as congenital fibrosis of the extraocular muscles.
  • Ageing: As the age progresses, the muscle that helps in holding up the eyelid, levator palpebrae superioris, becomes weak. This makes the eyelids droop slowly with time.
  • Eye injury: Any trauma to the eyes, due to continuous rubbing of eyes, getting a blow in the eye or due to wearing contact lenses for years, can damage the levator palpebrae superioris. 
  • Infection in the eyes: Eye infections such as conjunctivitis and stye can make your eye swell, thus resulting in drooping of the eyelid. However, the eye gets back to normal in one to two weeks. 
  • Eye surgery: After some eye surgeries such as cataract, glaucoma, or LASIK surgery (for improving eyesight), the patient may present with drooping eyelids. This is mostly temporary and wears off on its own.
  • Nerve damage: Peripheral nerves are the ones which connect different organs of the body to the brain and spinal cord. Any injury to the peripheral nerves that help in the functioning of eyelids can result in drooping of the eyelids. 
  • Brain aneurysm: A brain aneurysm (an enlarged part of a blood vessel in the brain) can press down on the oculomotor nerve, the nerve which supplies blood to the eye and eyelid. This results in drooping of the eyelid, and reduced movements of the eye and large pupil.
  • Eye tumour: Any tumour in the eyelid may cause your eyelid to weigh down. One of the most common eye tumours is neurofibromatosis type 1 (NF1). It is not cancerous but it can make the eyelid thick, thus making it droop.
  • Myasthenia gravis: Myasthenia gravis is a neuromuscular disease in which the immune system attacks the nerves and muscles, affecting the muscles of the eyes, face and throat. The patient can present with double vision, drooping eyelids, trouble talking, and trouble walking.
  • Horner's syndrome: Horner's syndrome (oculosympathetic paresis) is a condition in which there is some disorder in the nerve pathway which connects one side of the face and eyes to the brain. The affected side of the face presents with drooping eyelid, smaller pupil, and no sweat on the affected part of your face. 
  • Stroke: When someone is having a stroke, the oxygen to the brain gets blocked—either due to the bursting of a blood vessel or due to a blood clot. Stroke can lead to sudden drooping of the eyelid and face, weakness, difficulty in speaking and walking.
  • Diabetes: Uncontrolled high blood sugar, medically called diabetes, can result in damage to the blood vessels and nerves in and around your eyes over time. This can result in drooping of the eyelids along with double vision. This is also seen in a medical condition called diabetic third nerve palsy (oculomotor nerve palsy). 
  • Thyroid dysfunction: Low levels of thyroid hormone, as seen in hypothyroidism, can result in drooping of the eyelids and puffiness in the face.
  • Neuromuscular condition: Neuromuscular conditions (conditions affecting nerves and muscles) like oculopharyngeal muscular dystrophy can result in droopy eyelids, difficulty swallowing (dysphagia), and difficulty speaking (dysarthria). 

Can drooping of eyelids be prevented?

Drooping of eyelids cannot be prevented as it does not give any prior indications.

Drooping eyelids diagnosis

For diagnosing this condition, the doctor would first perform a physical exam of the affected eye or eyes. After that, a detailed symptomatic history would be taken, which would not only include the eye-related symptoms but other symptoms as well which include the presence of double vision, muscle weakness, trouble in speaking or swallowing, continuous headache and numbness in any part of the body. 

The doctor may also prescribe some scans and blood tests based on the other associated symptoms. For instance, a computed tomography scan (CT scan) and magnetic resonance imaging scan (MRI scan) would be advised if the person presents with neurological signs or there is an unknown mass inside the socket of the eye. 

The doctor may also prescribe a blood test and a Tensilon test if the person complains of muscle weakness along with the eye symptoms. In the Tensilon test, the person is injected with edrophonium chloride which completely cures the muscle weakness for a few minutes in the people who have myasthenia gravis. 

Treatment for drooping eyelids

The treatment of drooping eyelids depends on the underlying condition. For instance, if the drooping is due to hypothyroidism, the doctor will give medications to maintain the levels of thyroid hormone in the body. Similarly, if ptosis is due to a brain aneurysm, the doctor would treat the aneurysm for treating the condition. 

For congenital or idiopathic cases, there are nonsurgical options which may involve using fillers and laser procedures and surgical procedures which involve removing the excess skin or muscle from the affected eye. Congenital means from birth and idiopathic cases are those for which the cause is unknown.

  1. Surgical treatment of drooping eyelids
  2. Non-surgical treatment of drooping eyelids

Surgical treatment of drooping eyelids

Surgical treatment of ptosis is usually done to prevent any visual impairment and also to improve the appearance. The surgery does not promise the proper functioning of the levator muscle. In most adult patients, the surgery is an outpatient procedure and is done under local anaesthesia. However, during childhood, the eyelid surgery is performed under general anaesthesia.

Eyelid lift surgery can be performed on upper and lower lids by removing fat and muscle and tightening the skin around eyes. The most common surgeries are:

  • Blepharoplasty: Blepharoplasty is the surgical treatment in which the surgeon removes the excess skin from the upper eyelids and removes bagginess from the lower eyelids to open up the eyes. This procedure is also called an eye lift.
  • Levator resection: Levator resection involves removal of some of the levator palpebrae superioris muscle thus making it short. This makes the eyelid short, so it looks similar to the other eye.
  • Frontalis sling: If the levator muscle does not have any residual function, the drooping eyelid is corrected by connecting the margin of the eyelid to the muscle present in the forehead (frontalis muscle) using sutures, silicone, or fascia (a sheet of connective tissues) either from a donor or from the patient themselves. Thus the eyelid functions according to the functioning of the frontalis muscle.

Non-surgical treatment of drooping eyelids

The non-surgical treatments of drooping eyelids involve the following:

  • Botox: Botox is popularly used for cosmetic treatments like clearing face wrinkles. But it can also be used to create a brow lift so that the eyebrow of the affected eye rests at the same place as that of the normal eye. 
  • Fillers: Fillers are used in the lower eyelid to create a fuller look in the eye which gives a rested appearance to the drooping eye. 
  • Laser treatment: The doctor may also use a laser procedure to tighten the skin underneath the eyelid to make it look similar to the other eye.

Doctors for Drooping eyelids

Dr. Bhavna Harshey Dr. Bhavna Harshey Ophthalmology
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Dr. Upasna Dr. Upasna Ophthalmology
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