Hey there, I think I may have Ptosis in my left eye. I've noticed it for the past 6 years at least now, could be more. What do you think it is? and in saying that what can be done to fix this? It doesn't matter to me what needs to be done, I will have it done. PS- As the day later and as I get more tired, I notice it a lot more then what is shown in this picture.
Do I Have Ptosis in my Left Eye?
Doctor Answers 7
You have definite left upper eyelid ptosis, with left brow compensation meaning left brow higher trying to help lift that eyelid. Eyelid ptosis surgery, likely done from internal posterior approach (no skin incision), which can be done under local anesthesia, will likely benefit you. See an oculoplastic surgeon.
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You don't have ptosis of your left upper eyelid. This lid looks longer because the left orbit is larger than the right orbit; and without orbital fat to cameoflage this the left eyelid looks droopier. However, the lower margins of both upper lids cross the upper part of the pupil equally (no ptosis). Fat grafting under the left brow would remove the 'hollowness' of the left orbit/eye and make both eyes look more symmetrical. Both eyelids are slightly ptotic. Surgical correction of this may not be worthwhile.
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Classic Example of Ptosis
You have the classic appearance of ptosis. This includes the eyelid being lower on the affected side (your left), a higher eyelid crease on that side, and a higher eyebrow on that side.
What has happened is that the muscle that holds the eyelid open (the levator palpebrae) has a weak attachment to the eyelid itself (the tarsal plate). The result is that the eyelid does not open as much. This is not to be confused with droopy eyelid skin where you have a flap of skin falling over the eyelid. Ptosis is measured by how high the eyelid is at the edge where it touches the eyeball and is not related to how low any flap of skin may or may not droop.
When you have a poor attachment of muscle to the eyelid (tarsal plate), the muscle "tries harder" to open the eye. This results in it "sucking in" the eyelid skin above the tarsal plate (the muscle is also loosely attached to the skin) and you see the high crease and hollow look. Also, your brain tries to help the eyelid by telling the forehead muscles to contract on that side and the eyebrow moves up a little.
There are two basic ways to fix this. One is through the inside of the eyelid. This is an easier procedure and leaves no scar. On the down side, it is not as effective with more people needing a second procedure. The other way is to make a skin incision and re-attach the muscle directly. This is the most effective technique but has a bit more healing and leaves a scar.
Excellent review of ptosis rectification by Dr. Amadi. It is too bad that insurance does not really cover patient's medical issues, but the reconstructive repair is considered "Cosmetic Surgery."
Yes you have eyelid ptosis.
In this photo, the left side is heavier than the right side. However, the right side is not that open and I suspect you may be one of these individuals who has bilateral upper eyelid ptosis that is worse on one side. Consult an oculoplastic surgeon for an appropriate work up of this issue. The American Society for Ophthalmic Plastic and Reconstructive Surgery maintains a geographic directory on their website to help you identify a highly qualified surgeon in your area. Their site can be found by searching the Society name on the internet.
You are exactly right. You have a mild left upper eyelid ptosis [droop]. This is likely not severe enough to cause a visual field deficit, so insurance will not cover the cost of surgery.
There are two ways to address this surgically. The techniques differ in the approach and in the muscle that is operated on. In one method, the incision is made through the skin to tighten the muscle that is closest to the skin [levator muscle]. The second approach is through the underside of the eyelid without any skin incisions. In this technique, the eyelid is flipped and the Mullers muscle is tightened. This elegant approach is my preferred technique, as it is more reliable in producing accurate results, and causes less swelling/bruising without any visible scars/incisions. I have attached the pre and post photos of one my patients that underwent this type of surgery.
If you decide to explore this further, I would recommend consultation with an ASOPRS trained Oculoplastics surgeon. You can find one close to you on the ASOPRS dot org website. There are probably surgeons in BC that you can consult.