Adult-onset drooping of the eyelids: Myths and Challenges

Hey hey! I am back after a long time and as promised earlier, let us discuss about the drooping of eyelids in adults.

Firstly, we need to understand that drooping of eyelids in adults can be due to various reasons: due to trauma to the eyelid or forehead, nerve-related issues, muscle-related issues or due to a mass/swelling involving the eyelid.

We shall focus on the most common reason for the droop: age-related drooping of eyelids or in medical terms – aponeurotic ptosis

The eyelid is kept in position by mainly the Levator palpebrae superioris (LPS) muscle, and this is supported minimally by the Muller’s muscle

WHAT CAUSES THE EYELID TO DROOP?

Few reasons postulated are:

1. The most common cause is age-related: advanced age with long term effect of gravity and ageing causes the LPS muscle to stretch. The muscle becomes thin and looses its tone. It becomes weak and is unable to hold the eyelid in position
2. History of eye allergy or continuous itching
3. Long term use of rigid contact lens
4. Trauma to the eyelid or brow region
5. Repeated attacks of swelling involving the upper eyelid
6. History of previous surgery on the eye, for eg: cataract surgery

WHAT ARE THE SYMPTOMS?

1. Tired or sleepy appearance
2. Blurred vision – more so when looking down or reading, climbing up stairs, driving
3. Head tilt or chin up position of the face: to increase the field of vision
4. Change in the facial appearance: high brows to lift the eyelid mechanically
5. Eye strain and headaches

Most of these changes are first visible on photographs. So a closer look at photographs can be helpful.

Surgical correction of the eyelid droop is the only way to bring the eyelid to correct position and improve the facial appearance.

MYTH:

• Exercises helps in resolution of this variety of ptosis

We need to understand the problem is either the muscle is too weak due to excessive stretching or it is not in its position. So no amount of exercise is going to fix the problem.

• Eyedrops and eye ointments can cure the ptosis

No, it cannot cure the droop as the problem is in the anatomy and it is not a disease.

CHALLENGES:

• Ptosis can present in combination with other age-related changes like drooping of the eyebrows (Brow ptosis) or excessive skin in the upper eyelid (Dermatochalasis): Here in addition to correction of ptosis, we may have to correct the eyebrow droop and remove the excess upper eyelid skin to achieve adequate correction.

• Sometimes, eyelid droop can be due to the excess skin or brow droop alone (Pseudoptosis). Once these two conditions are corrected, the eyelid then looks normal.

NOTE: There are many other causes of drooping of eyelids in adults – therefore any doubts or concerns, please consult your eye doctor. Also, you can freely write to me for any further clarifications if needed.

I hope this was helpful. I will come up with more frequently encountered questions in the clinic with logical and scientific explanation for the same.

Dr Nandini Bothra
Consultant, Govindram Seksaria Institute of Dacryology,
Ophthalmic Plastic Surgery Services,
L V Prasad Eye Institute, Hyderabad.
Email id: nan_bothra@yahoo.com