Oculoplastics
Droopy Eyelid (Ptosis) Repair
A droopy upper eyelid is called ptosis (say “TOE-sis”). The lid sits lower than it should, so it can cover part of the pupil. Some people notice they look tired. Others find they raise their eyebrows all day to see, which can cause a tired forehead or headaches. Ptosis can be repaired with surgery. This page explains what causes it, which signs need urgent care, how it is assessed, and what repair involves.
Ptosis or extra eyelid skin?
Ptosis is different from extra eyelid skin. With ptosis, the eyelid itself sits too low. The muscle that lifts the lid, or the tendon that attaches it, has stretched, thinned or weakened. With extra skin (dermatochalasis), the lid is in the normal place, but a fold of skin hangs over it. The two often happen together. A careful exam tells them apart, because the surgery for each is different. Our guide to upper and lower eyelid surgery explains the surgery for extra skin.
What causes a droopy eyelid?
Age is the most common cause in adults. The tendon of the lifting muscle slowly stretches over many years. Long-term contact lens wear, eye surgery and injury can speed this up.
Some children are born with ptosis. A droop that covers the pupil in a young child needs prompt assessment, because it can affect how vision develops.
Less often, ptosis is a sign of a nerve or muscle condition. These causes need a medical diagnosis before any eyelid surgery is considered.
When a droopy eyelid is urgent
Get help the same day if a droopy eyelid comes on suddenly. Go to an emergency department right away if it appears with any of these:
- double vision
- a severe headache
- one pupil larger or smaller than the other
- weakness in the face, arms or legs
See a doctor soon if the droop comes and goes, or gets worse as the day goes on, especially with tired muscles or trouble swallowing.
How ptosis is assessed
Your assessment starts with your history and the health of your eyes. Your surgeon measures how far the lid sits from the centre of the pupil and how well the lifting muscle works. A visual field test checks how much the lid blocks your side vision. Photos are taken for your record.
Your surgeon also checks your tear film and the front of your eye, because a lid that is lifted higher can let the eye dry out more. If dry eye needs treatment first, our sister clinic, U Dry Eye Institute (UDEI), can help.
How ptosis repair works
Ptosis repair tightens or reattaches the lifting muscle so the lid sits higher. Depending on the cause, the surgeon may work through a small cut in the natural crease of the upper lid, or from the inside of the lid. For a muscle that barely works, often in children, a different approach links the lid to the forehead muscle. If you also have extra skin, it can be removed in the same operation.
Ptosis repair is performed by Dr. Sangsu Han and Dr. Raj Maini of our oculoplastics service. The operation takes place at U Surgical Centre, our accredited surgical facility, or at a hospital where your surgeon holds surgical privileges.
Recovery after ptosis surgery
Most bruising and swelling settles in one to two weeks. Cold compresses, lubricating eye drops and a short break from heavy exercise help. Your eyes may feel dry or slightly irritated at first. The lid height keeps settling for several weeks. Results vary from person to person, and you will have follow-up visits to check healing.
Risks, and who it may not suit
Like any surgery, ptosis repair has risks:
- the lid can end up higher or lower than planned, or the two sides can differ
- some people need a second, smaller operation to adjust the height
- the eye can feel dry, and you may not be able to close it fully for a while
- infection, bleeding and noticeable scarring are uncommon
- very rarely, bleeding behind the eye can threaten vision, which is why you get clear instructions on what to watch for
Ptosis surgery may not be right for you yet if a nerve or muscle condition has not been diagnosed, or if severe dry eye has not been treated first.
Is this medical or cosmetic eyelid surgery?
Ptosis repair is medical eyelid surgery, and it is assessed through Uptown Eye Specialists. If your main concern is appearance, such as heavy upper lids or under-eye bags, our sister clinic offers cosmetic eyelid surgery at U Eye Laser Cosmetic (UELC) with the same surgeons.
Common questions about ptosis
Is a droopy eyelid the same as extra eyelid skin?
No. With ptosis, the eyelid itself sits too low because the muscle that lifts it has stretched or weakened. With extra skin (dermatochalasis), the lid sits in the normal place but a fold of skin hangs over it. They can happen together, and the treatment is different, so your surgeon checks for both.
Can a droopy eyelid be fixed without surgery?
Not when the lifting muscle has stretched. Laser and skin treatments can tighten skin, but they cannot shorten or reattach the muscle. If a droop comes and goes, or appears with other symptoms, it needs a medical check first, because the cause may not be in the eyelid at all.
Will I be awake during ptosis surgery?
Most adult ptosis surgery is done with local anaesthetic, often with light sedation. Many surgeons ask you to open your eyes during the operation so they can set the lid height while you look straight ahead. Your surgeon will explain the plan for your surgery.
How long is the recovery?
Most bruising and swelling settles in one to two weeks. The eyelid height keeps settling for several weeks after that. Recovery varies from person to person, and you will have follow-up visits to check healing.
Can a droopy eyelid come back after surgery?
Sometimes. The lid can sit a little higher or lower than planned, or the two sides can heal slightly differently. A small number of people need a second, smaller operation to adjust the height. Your surgeon will talk through your own risk before you decide.
Getting assessed
Ask your optometrist or family doctor for a referral to our oculoplastics service. Here is how referrals work. Bring a list of your medicines and any old photos that show how your eyelids used to look.