Is this ptosis or just eyelid asymmetry? (photos)

Question

I've developed assymetry in my eyes and am wondering if it is due to ptosis, pseudoptosis or neither. I'm also looking for recommendations as to what can be done to correct it. Thanks!

A.J. Amadi, MD · Answer

From your photo, it appears that you do not have a well formed crease on your right upper eyelid. As a result, the skin is hanging over your lashes and giving the impression of eyelid ptosis, without truly being ptosis. "Asian Blepharoplasty" is likely the solution, to create a so called "double eyelid", like you have on the left. But, an in person evaluation of your eyelids in an open and closed position, along with a dynamic presentation  (seeing the act of opening and closing" would be very helpful.Best regards

Soheila Rostami, MD, FAAO, FAACS · Answer

It appears that your epicanthal fold is lower on the right compare to the left upper eyelid. This could be pulling the skin over the lid margin and your eyelid margin may be higher. SO they call this pseudoptosis. So if you hold the skin away from the upper eyelid margin, then you can tell if this is a true ptosis or appears as ptosis. If the eyelid margin is higher than the skin of the upper eyelid, then you have no true ptosis.

Austin Hayes, MD · Answer

Ptosis refers to an abnormally low position of the upper eyelid margin in relation to the eyeball. The upper border of the Iris (colored part of the eye) is used as a landmark to reference the location of the eyelid margin. The location of the eyelid margin can be 1 mm above or up to 3 mm below the upper border of the Iris (upper limbus). The position of the eyelid margin should be symmetrical. Some patients believe that they have ptosis, when in fact there eyelid margins are in a normal position. The asymmetry that they notice may actually be a result of asymmetrical upper eyelid skin. This can be addressed with eyelid surgery. If patients are troubled by this asymmetry, then consultation with a local surgeon who is comfortable with upper eyelid surgery, will help them determine how to proceed.

Thomas Buonassisi, MD · Answer

Thanks for sending your photos. You have some degree of asymmetry but from your photos its does not look like ptosis. Ptosis is when the eyelid margin itself rests lower on the eyeball than is normal. It appears that your skin on the R is hanging down further than the left but the margin looks OK. You have a well formed crease on your left but no crease on the Right. One option would be to surgically create a crease on the R side to improve the symmetry. Of course an in person physical exam would be needed to be sure.Best of Luck

Is this ptosis or just eyelid asymmetry? (photos)

Answers (4)

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