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The causes and severity of drooping eyelids can vary greatly from patient to patient. Thus, properly diagnosing and treating the condition can be a challenging and complex process. Cedars-Sinai Marina del Rey Hospital offers various diagnostic methods and a wide range of treatment options for dropping eyelids. Our highly skilled surgeons can promptly attend to each case when damage to the eyelid muscle cannot be reversed using non-invasive procedures.
Drooping eyelids occur when one or both upper eyelids start to fall, covering the eye and sometimes reducing or completely blocking the visual field. It is a relatively common condition and it does not cause any painful symptoms. Drooping eyelids are caused by damaged levator muscles (levator palpebrae superioris), which are situated in the orbit of the upper eyelid and are responsible for raising and closing the eyelid.
This condition is caused by various factors, ranging from the natural weakening of the muscles surrounding the eye to nerve damage or trauma. It can also be present at birth. Treatment may or may not be required, depending on the severity of the case. When drooping eyelid is congenital or does not impair one’s vision greatly, it will often be left untreated or allowed to resolve itself. Surgical intervention may be required when drooping eyelids create major difficulties for the patient, or when the condition places them at a high risk for developing complications like amblyopia (lazy eye) or astigmatism.
When the condition does not severely impact one’s vision and when the risk of developing serious complications is very low, drooping eyelids generally do not require surgery. Instead, the patient may be given glasses with an attached crutch to help elevate the eyelids. If drooping eyelids cause major distress in the patient’s life due to partially or completely blocking their vision, the condition can be surgically treated. Local anesthesia is generally used during these procedures so that the patient can move their eyelids and the surgeon can accurately adjust their position. There are three types of surgery used to restore the eyelid’s normal position and function: Muller’s muscle conjunctival resection (MMCR), levator advancement, and frontalis sling.
Muller’s muscle conjunctival resection (MMCR) can result in a 1-2 mm elevation of the eyelid. This is a minimally invasive procedure that does not leave any visible scars. There are a number of advantages to MMCR, including quick recovery time, low risk of additional surgical interventions, and extremely low health risks.
Levator advancement provides a higher degree of eyelid elevation than MMCR and can be used when MMCR fails to achieve the desired result. It involves an incision in the upper lid so that the levator muscle can be restored. This procedure is not recommended to patients whose levator muscle completely fails to elevate the eyelid, as there is a significant risk of ptosis reappearing.
When poor levator muscle function is present, the frontalis sling approach may be the most suitable type of surgery for ptosis. In such cases, the movement of the eyelid depends solely on the frontalis muscle. In the frontalis sling approach, the frontalis muscle is connected to the eyelid with slings, allowing the patient to properly elevate and close the eyelids. This type of surgery typically uses one incision on the upper eyelid surface and three small incisions above the eyebrow.
Drooping eyelids can also be a symptom of very serious underlying conditions, such as diabetes, myasthenia gravis, muscular dystrophy, nerve or muscle cancer, stroke, or brain tumors. In this case, ptosis should subside when the underlying issue is properly addressed.
Ptosis can be either congenital or acquired. Cases of congenital drooping eyelids are rare and most commonly caused by an improper development of the levator muscle, which can be attributed to a series of factors such as blepharophimosis syndrome, birth trauma, or nerve palsy. Children born with ptosis also have a higher risk of developing other eye-related conditions, such as amblyopia (lazy eye), which seriously impairs the vision. There are five types of ptosis, depending on its cause: aponeurotic, neurogenic, myogenic, mechanical, and traumatic.
Aponeurotic ptosis is the most common type of ptosis. It generally occurs due to the natural weakening and overstretching of the levator muscle associated with aging. Other causes for aponeurotic ptosis are excessive eye rubbing and long-term wear of rigid contact lenses. It typically affects both eyes, although one eyelid may appear to droop significantly lower than the other.
Nerve-related conditions such as myasthenia gravis, nerve palsy, and Horner’s syndrome often cause neurogenic ptosis, since these may also affect the levator muscle in the upper eyelid. Diabetes, brain tumors, multiple sclerosis, and brain aneurysms are all risk factors for developing this type of drooping eyelids.
Myogenic ptosis can occur when a person suffers from chronic muscle diseases or disorders. Myasthenia gravis, myotonic dystrophy, mitochondriopathy, several types of muscular dystrophy, and ophthalmoplegia are some of the conditions commonly associated with myogenic ptosis. The prognosis of drooping eyelids is dire in these cases, as the chronic nature of these underlying causes impairs recovery after surgery has been performed.
Mechanical ptosis occurs when the levator muscle cannot raise the eyelid due to a heavy mass on its surface, such as a lump, infection, or tumor. It can also occur when there is excess skin weighing down the eyelid, as well as when blepharochalasis or orbital fat prolapse is present.
Traumatic ptosis is a result of trauma to the eye that causes the levator muscle to be damaged. Severe trauma can also produce nerve damage in this area.
Sometimes, what appears to be a case of drooping eyelids is in fact the effect of a different condition, such as dermatochalasis (excess skin hanging on the surface of the eyelid, which does not put a strain on the muscle), or eyebrow ptosis (the lowering of the eyebrow, which may cause the eyelid to appear drooped). This is called pseudoptosis.
Besides the visibly lower position of one or both eyelids, the following symptoms can often accompany ptosis:
Although drooping eyelids can be easily diagnosed by a standard physical exam due to the drastic change in the appearance of the eye, a series of additional tests and examinations are often required to confirm the diagnosis and find the underlying cause, if there is one. These are the most common methods used in diagnosing ptosis:
Ophthalmic examination: If ptosis is suspected, the doctor may perform a thorough eye examination in order to observe potential abnormalities. This may involve a slit lamp exam during which the eyes will be carefully looked at under a high-intensity light. The patient might feel slight discomfort if their eyes are dilated before the procedure.
Neurological examination: Since numerous cases of drooping eyelids can be the result of nerve-related conditions, nerve damage, and brain tumors, a neurological exam may also be required to confirm or infirm such underlying causes.
Tensilon test: When ptosis is believed to occur due to a muscle disease, such as myasthenia gravis, the Tensilon test may be used. It involves the patient being administered edrophonium chloride intravenously so that the doctor can observe the movement of their eye muscles. If the medicine improves the strength of the muscles, this may indicate the presence of a muscle condition.
CT scan/MRI: Underlying neurological conditions and brain tumors can be accurately diagnosed using a computed tomography scan or magnetic resonance imaging.
The presence of one or more of the following factors can trigger the occurrence of drooping eyelids:
Chronic muscle diseases: Muscular dystrophy and myasthenia gravis are only two of the numerous conditions that can place one at a higher risk of being diagnosed with myogenic ptosis due to the strain such diseases can put on the levator muscle.
Neurological disorders: Neurogenic ptosis is the result of nerve-related conditions such as Horner’s syndrome, brain aneurysms, brain tumors, or nerve damage caused by diabetes. Suffering from one or more of these conditions can increase the chances of drooping eyelids.
Age: The most common type of ptosis (aponeurotic) often affects the elderly. Because muscles tend to lose their strength over time, people over the age of 50 are more prone to developing drooping eyelids due to the weakening of the levator muscle.
LASIK or cataract surgery: Drooping eyelids can also appear after a patient has undergone LASIK or cataract surgery, though such occurrences are rare. The overstretching of the eyelid muscle that can happen during these procedures can lead to ptosis. However, drooping eyelids do not typically represent a serious affection in such cases and tends to resolve itself within a few days. Permanent ptosis caused by eye surgery is extremely rare.
Drooping eyelids, either congenital or acquired, can often be the result of one of the following causes:
There is no scientifically proven alternative treatment method for drooping eyelids. However, mild cases of ptosis may improve with one or a combination of the following treatments:
Myogenic ptosis, in particular, is believed to respond well to facial and scalp acupuncture, since the intramuscular needling techniques promote muscle relaxation. It can also alleviate ptosis associated symptoms, such as tension headaches.
Natural remedies and supplements may also help improve ptosis symptoms by promoting nerve and muscle strengthening. Some of the most commonly recommended remedies for drooping eyelids are:
There are a series of exercises involving the muscles in the eye region designed to aid in ptosis treatment. These include upper eyelid stretches and lower eyelid squints. Wearing a patch over the healthy eye is also believed to force the affected eye to regain strength, as it will be exclusively used.
It is impossible to predict whether a person will develop drooping eyelids during their lifetime, regardless of the presence of associated diseases or their age. Still, there are ways to lower your risk of acquiring the condition:
Getting your eyes regularly checked: Annual ophthalmic examinations can reveal potential abnormalities of the eye, which may lead to a type of ptosis if left untreated.
Maintain a healthy weight: Since drooping eyelids can also be caused by mechanical factors, such as the growth of heavy masses on the surface of eyelids, avoiding fat accumulation may decrease your chances of developing this type of ptosis.
Avoid smoking: Aponeurotic ptosis is often associated with smoking and secondhand cigarette smoke. Thus, it is highly suggested you avoid smoking, as well as smoke-filled environments whenever possible.
Are you experiencing symptoms associated with drooping eyelids? The surgeons at Cedars-Sinai Marina del Rey Hospital can provide you with information and treatment options for your specific condition.