Why do the eyelids droop?
Droopy eyelids correspond to ptosis. It is a situation meaning that, for different reasons, the upper eyelid cannot open normally, and patients are unable to open their eyes normally or naturally. This affects vision in many cases as there is a failure involving the eyelid opening.
There are many different causes of eyelid ptosis. However, all the patients come to see us because they've noticed a "droopy eyelid". This may simply be an aesthetic issue, or may even affect the eyesight because the upper eyelid "covers" the pupil and the person affected is unable to see out that eye.
This is most important when it comes to children, since a low lying eyelid may lead to the development of lazy eye, which would make consulting a specialist preferable and a priority.
The aetiology of eyelid ptosis is very varied, fundamentally with diverse effects on the levator muscle of the upper eyelid. This is the most important muscle involved in eyelid opening, and the eyelid failing to close properly is practically the norm.
The most common type of ptosis is involutional, or aponeurotic, which mainly occurs in older people due to ageing. In these cases the levator muscle might be completely healthy and work well, but the ageing processes affect its tendon, known as aponeurosis. This structure lengthens and stops having the consistency and tension required to work properly, so the upper eyelid droops.
The second most common aetiology is congenital ptosis. It comes about during childhood, even after birth, and it is based on a levator muscle function fault. The patient is born with a malfunctioning levator muscle, whereby regardless of its states of aponeurosis, it is not capable of performing its function properly. In these case, if the involvement is significant and the pupil is affected, it is fundamental to see a specialist as soon as possible, to asses the visual function of the eye and prevent the development of amblyopia, commonly known as lazy eye. If the visual axis is not affected, it becomes a type of aesthetic ptosis, and should be corrected whenever the patient or their parents see fit.
Other palpebral ptsosis aetiologies are mechanical, neurogenic and traumatic.
There really is no way of preventing eyelid ptosis, but its effects on the eyesight can be minimised quickly and early, which is essential for young children whose eyesight is still developing.
Treatment for eyelid ptosis is always surgery. Depending on the causing aetiology and, above all, the levator muscle function, one technique will be chosen over another. In terms of the timing of the treatment, it will always depend, in the case of children, on the chance of them developing a lazy eye.
Frequently asked questions
The surgical solution is very stable over time. Once the correct position has been obtained, it usually stays in place for many years, if not for the rest of your life, without requiring any modifications. An exception to this general rule are patients affected by progressive muscular disorders, whereby the evolution of disease may entail a new ptosis despite having undergone completely correct surgical treatment.
Ptosis surgery will allow normal opening of the eyelid, but it shouldn't change its closing. If that happens, it will have to be fixed, but in no case is it a common surgical complication of surgery.