Drooping eyelids is a condition that negatively affects the eye health and psychology of patients. In addition to not being able to obtain clear vision, the eye covered by the eyelids may also trigger some eye-related disorders, especially in children. Aesthetic anxiety, on the other hand, can disrupt the patient’s mental health, prevent him from socializing, and may even affect his career choice.
Before explaining the causes, who it is seen in, and treatment options, it is useful to explain exactly what the problem of drooping eyelids is:
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What is Ptosis?
Drooping eyelid is one of the common eyelid diseases and is referred to as ptosis in the medical literature . In this disease, the upper eyelid droops downwards.
In order to be considered to have droopy eyelids , the lid must cover the colored part of the eye more than normal (1 to 1.5 mm). Although it is commonly seen in one eye, it can also occur in both eyes (bilateral ptosis).
What kind of symptoms does ptosis cause?
The most basic symptom of ptosis is the appearance of drooping eyelids, but this symptom is not mild, but can be easily noticed in cases where it even covers the pupil or occurs in one eye. (Although it is mild and cannot be noticed from the outside at the moment, the patient can see the difference if he compares his face/looks in the photos he took today with the photos he took in the past.)
There are other symptoms that may suggest the presence of droopy eyelids . What stands out among these is that the patient often lifts his eyebrows – and therefore his upper eyelids – upwards in order to obtain a clearer vision, as the drooping eyelid restricts vision.
For this purpose, the patient sometimes uses his hands. Similarly, he can try to make it easier for him to see by lifting his chin up and tilting his head back. All these strains may cause wrinkles around the patient’s eyes and forehead or pain in the neck and back in the future. Dryness or, on the contrary, excessive watering are symptoms that bring to mind the presence of ptosis .
When viewed from the outside , drooping eyelids may also manifest itself as the patient’s expression becoming dull or his/her face looking tired even though he/she is rested.
What are the Causes of Droopy Eyelids?
The cause of ptosis varies between patients. However, when a general classification is made, it is possible to say that ptosis is congenital or appears over time, and therefore can be seen in individuals of all ages.
If there is congenital ptosis, that is, congenital droopy eyelids, there is -usually- a developmental disorder in the muscle that lifts the eyelid (levator muscle). Although this muscle is developed from birth, it can become thinner and separate from the socket to which it is attached as the person ages. In such a case, advanced age-related ptosis occurs.
When a classification other than “congenital” or “non-congenital” is desired, the causes of drooping eyelid can also be taken as basis: Eye injury/trauma, long-term use of contact lenses, damage to the nerves directing the muscle that lifts the eyelid, masses appearing on the eyelid, eye tumors, some nerve and muscle diseases, allergic diseases, etc. Health problems can cause ptosis.
In addition, some interventions in previous eye surgeries and medications used to treat any disease may also cause drooping eyelids.
How Is It Diagnosed?
During the eye examination to diagnose ptosis, the patient’s history is first listened to. Issues such as when the symptoms that suggest the presence of droopy eyelids begin and how often they occur are clarified.
The visible droopy lid when viewed from the outside helps to make the diagnosis easily. However, whether it is noticeable or not, the ophthalmologist uses some tests and examinations to diagnose ptosis and determine its cause. Such as biomicroscopy (slit lamp) examination, neurological imaging and blood tests. The difference in aperture between the newborn’s two eyes is also a stimulus for additional examinations. In such a case, the baby’s eyelid folds are examined through physical examination.
How to Treat Droopy Eyelid?
If the trigger for eyelid drooping is not a systematic disorder, the intervention is the levator muscle , which is responsible for lifting the eyelid but cannot perform this task by working inadequately or not at all .
In the presence of ptosis , the only effective treatment method that provides results in a short time is surgery. The surgery is performed in adults using local anesthesia and without the need for the patient to lie down (standing). Eyelid surgery is a simple surgery that is completed in a short time . If no complications occur after the surgery, patients are discharged within a few hours.
The method to be used in the surgery to treat droopy eyelid is determined according to the condition of the levator muscle. In this context, in case of drooping valve that causes mild symptoms or occurs due to aging, a method is chosen that will strengthen the underactive muscle.
If the lavator muscle does not work at all or ptosis occurs due to nerve paralysis, the sling method is preferred. With this method , the drooping eyelid is suspended from under the skin to the forehead muscles with the help of silicone bands. The choice of method may also be affected by the movement of the eye and the function of the tears. (Depending on the level of sagging, the physician may also remove excess tissue during surgery.)
If ptosis in children is not advanced or occurs in one eye, surgery may not be required in the first place – taking into account the triggering factor and keeping the patient under close supervision. The age of the patient, as well as his health condition, is also effective in making this decision. If the option of surgical intervention is currently ruled out, the doctor may ask the child to wear special glasses, cover the healthy eye with a pad, or recommend using drops for the problem eye.
In such cases, which are left to time and supported externally, it is essential to routinely check whether there is a regression in the eyelid ptosis, as these checks also indicate whether there is a need for surgical intervention.
If surgery is decided immediately after the diagnosis of congenital eyelid droop or after a while, the level of ptosis affects the choice of surgery method. In cases of mild eyelid ptosis, the aim is generally to strengthen the levator muscle.
In severe cases, the sling method may be preferred, as in adults. Since droopy eyelids, which prevent vision, are likely to cause amblyopia in children , it is very important to make the diagnosis early and start treatment without wasting time. The critical period for diagnosis and treatment is the preschool age.
When the factor causing droopy eyelids is a systematic disease, the treatment of the disease in question should not be neglected.
Does Ptosis Cause Permanent Vision Loss?
Ptosis, which occurs after the age of ten, may be advanced in some patients. In other words, the sagging eyelid may descend to the pupil, which restricts the patient’s vision.
However, this limitation disappears after the problem is surgically intervened. If congenital ptosis is present or if ptosis occurs between the ages of one and ten, it is possible that vision loss will be permanent. Therefore, treatment should be started without delay.
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