​"Many people do not notice they have developed droopy eyelids (ptosis) until the signs become obvious. Patients usually tell us that their eyelids were fine before. Droopiness comes with age, though in some cases, it is congenital," says Dr Sunny Shen, Senior Consultant at the Oculoplastic Service, Singapore National Eye Centre (SNEC), a member of the SingHealth group.

Droopy eyelid (ptosis) surgery is done by oculoplastic surgeons who are ophthalmologists (eye doctors) trained in plastic and reconstructive surgery around the eye. What the oculoplastic surgeon does is to repair the weakened eyelid muscle and in some cases remove excess eyelid skin and fat through a small incision in the fold of the eyelid.

What causes droopy eyelids (ptosis)?

Ageing is the most common cause of ptosis. As people age, the eyelid muscles gradually lose their strength and tone, basically through wear and tear and eventually failed to lift the upper eyelids.

Injury, neurological conditions (such as stroke, brain tumour) and muscular disorders may also cause droopy eyelids. If one should experience sudden onset of droopy eyelids (within hours and days), one should seek medical help immediately.

Sometimes, children are born with ptosis because of poorly developed eyelid muscles. Contact lens wearers are also susceptible to droopy eyelids.

Droopy eyelids can sometimes be associated with a drooping eyebrow (brow ptosis) and the development of excess eyelid skin (dermatochalasis). In some instances, the eyelid connective tissues are also weakened and the normal orbital fat prolapses forward, causing puffiness in the upper eyelids. All these conditions can involve one or both upper eyelids, and cause obstruction to one’s vision in addition to changing one’s physical appearance.

Symptoms of ptosis

  • Difficulty in keeping your eyes open or heavy eyelids due to increasing weakness of the eyelid muscles
  • Eye strain and eyebrow ache caused by constant effort to raise the eyelids 
  • A constant tired and sleepy look
  • Diminished vision if the upper eyelids partially cover the pupil
  • A constant head tilt backwards to help you see from under the drooping eyelids

Treatment

For those who wish to enhance their physical appearance or prevent droopy eyelids from obstructing their vision, surgery is recommended in most cases. This is a short and painless procedure done under local anaesthesia.

What to expect from ptosis surgery

There is usually minimal scarring from the surgery which is hidden as the incisions are made in the fold of the eyelids, and will not be visible once the incisions have healed.

Complications from ptosis surgery are rare. These include bleeding, infection, continuous eye pain and swelling, and difficulty in closing your eyes fully.

Any swelling or tenderness should subside within two to four weeks.

"The main goal of surgery is to improve the patient’s vision because ptosis can affect your daily activities," says Dr Shen.

"Surgery can also greatly improve the patient’s appearance. Drooping eyelids can cause forehead wrinkles and make you look older. Some patients come to see us because of an upcoming wedding or some other important life event. They want to look good in pictures," adds Dr Shen.

Ref. T12