Ptosis? Worsening at 24? (photo)

Question

I have always had drooping in my left eyelid (present in pictures from when i was a child). However, up until now it never really gave me trouble other than cosmetic. Now at 24 years old, I feel it may be worsening. Recently, I have been having headaches (on that side) and discomfort and more of on overall puffy feeling on that eyelid. Also, the conditions seem to degrade with fatigue. Basically, I'd like to know if I should see a doctor? Can it be corrected with surgery?

A.J. Amadi, MD · Answer

Eyelid can be caused by a variety of causes, muscle related [congenital], nerve related, or most commonly, age related.

	You are correct that if you've had this since you were very young, that it is likely congenital. Surgery can be quite helpful.

	I would recommend seeing an Oculoplastic surgeon. You can find one close to you by using the link below. Good luck.

Mehryar (Ray) Taban, MD, FACS · Answer

You have left upper eyelid ptosis (droopy). In your case, it is likely congenital but has gotten worse with age. It can be improved by ptosis surgery (tightening the muscle responsible for lifting the upper eyelid to elevate the upper eyelid). There are various techniques available for ptosis surgery, depending on a few factors (amount of ptosis, strength of the muscle, etc). See an oculoplastic surgeon.

Amiya Prasad, MD · Answer

Congenital ptosis is a condition where people are born with a drooping eyelid. In this condition, the muscle that lifts the eyelid did not develop and the muscle doesn’t contract nor relax. If the child has no significant ptosis that affects the vision before the age of 6, then correction can be done at a later time. Unfortunately, congenital ptosis can get worse as people get older as facial structure changes. Sometimes, people with ptosis compensate by raising their eyebrows. However, as one ages, the compensatory action doesn’t work anymore.

	In my experience, people with ptosis are particularly bothered if the eye affected is the dominant eye or the preferred eye where the brain wants to see out of that eye - it’s often referred as ocular dominance. It is possible that the source of your headaches is related to the activity of the muscle that raises the eyebrow called the frontalis muscle which causes you to have tension and spasms.

	If you have decided to have eyelid surgery for congenital ptosis, then the surgeon would do some type of surgery on the levator muscle. This muscle is responsible for lifting the eyelid. In my practice, I deal congenital ptosis in adult patients with a procedure called levator advancement. This procedure allows me to move the muscle forward but not sacrifice any of the muscle and avoid any resection. The eyelid would be in a more appropriate level within the social interaction. However, this procedure is variable from patient to patient. 95% of the time, it may work out great while 5% of the patients may need enhancement surgery.  I hope that was helpful, and thank you for your question.

Asif Pirani, MD, FRCS(C) · Answer

You need to see an ophthalmologist/oculoplastic surgeon at the very least.  There are several serious causes for eyelid ptosis that need to be ruled out.  You should obviously see your primary care physician about this to have you referred to the appropriate individuals.  

	Best,

Darryl J. Blinski, MD · Answer

You need to be evaluated by a neurologist, ENT, PS, and primary docs!! First find out if you have a disease issue causing this ptosis.

Ptosis? Worsening at 24? (photo)

Answers (8)