Ptosis – Droopy upper lid

Ptosis of the eyelid can be congenital (present since birth), or acquired. Children born with ptosis often need surgery at an early age so that the vision is not obscured. Childrens’ vision develops up to the age of about ten years. Failure to see through one or both eyes can lead to loss of best potential vision in the affected eye. It is for this reason that intervention is required early. Similarly, patching of the good eye is sometimes required to encourage good vision in the weaker eye.

In adults the most common form of ptosis occurs when the fine attachments of the lifting muscle of the eye become detached from the eyelid. This is an ageing process, but may be hastened by contact lens wear.

Rarely, muscle-weakening disorders such as myasthaenia gravis or nerve palsy may be the cause. Causes such as this, will be excluded prior to surgery.

Surgery aims to restore lid height to the natural position with skin creases, lid contour and symmetry restored. Sometimes excess skin, fact and muscle are removed if there is a bulky appearance to the lid (see Blepharoplasty).

Usually surgery can be performed under local anaesthesia, sometimes with mild sedation. This generally gets the best results and is recommended as the lid height can be set with your cooperation at the time of surgery.

Ptosis can be repaired from the inside of the lid – no skin incision, or from the outside through a skin crease incision.

In severe ptosis, with poor muscle function an internal sling to the eyebrow can be performed.

Banner image: Aponeurotic ptosis

© 2009 American Academy of Ophthalmology

This is a series of pre-op and post-op – on the operating table images of ptosis repair.

Courtesy Mr JRO Collin

This is a series of pre-op and 2 month post-op photographs of ptosis repair.


Pre and 6 weeks post bilateral upper lid blepharoplasty and ptosis procedure.

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