Drooping Eyelid = Ptosis
When a drooping eyelid falls low enough to cover the upper field of vision, patients may arch their eyebrows with their forehead muscles to compensate. In such functional ptosis cases, ptosis correction is important to restore the lost vision and is usually covered by regular health insurance. Less advanced ptosis may not block vision significantly but causes a “tired” or “sleepy” appearance. This aesthetic appearance often creates significant effects on self-image and interpersonal relations. To learn more about how ptosis can be improved, reach out to our ocular practice today. We have locations in Chicago Ridge, IL, Tinley Park, IL, and Munster, IN.
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What Causes Ptosis?
The most common cause of ptosis is the age-related effects of gravity. However, there are many other reasons why one or both eyelids may droop, including:
Congenital ptosis from malpositioned or maldeveloped of the levator muscle which usually lifts the lids
Neurogenic ptosis: Defective nerve to the levator muscle is defective (third cranial nerve palsy)
Neurogenic ptosis: Defective nerve to the orbicularis muscle (seventh cranial nerve palsy, or Bell’s palsy)
Neurogenic ptosis: Defective nerve to the Muller’s eyelid muscle (Horner syndrome)
Neurogenic ptosis: Associated with myasthenia gravis or multiple sclerosis
Mechanical ptosis: Excessive contact lens use, eyelid tumors, or even large chalazia
Involutional ptosis: The most common form of ptosis, where aging causes stretching and weakening of the levator tendon
Ptosis Treatment Options
Unfortunately, ptosis does not respond to eyelid exercises, as muscle weakness is not the problem per se. In years gone by, special glasses might be used to “prop open” the drooping lid, and occasionally patients would tape the lid up. Fortunately, we now have many safe and effective surgical approaches to ptosis, including:
Levator muscle tightening (external approach) – This is the most common approach, shortening and repositioning the main eyelid lifting muscle through an eyelid crease incision.
Muller’s muscle tightening (internal approach) – In this technique, appropriate for smaller amounts of ptosis, the lid is “flipped” inside-out, and the Muller’s muscle is tightened from the backside of the eyelid.
Fasanella-Servat procedure – This technique also uses the flipped or everted approach to shorten the lid by removing multiple layers rather than just repositioning them.
Frontalis sling approach – When the levator muscle is extremely weak, typically in severe congenital ptosis, the eyelid is directly attached to the forehead (frontalis) muscle.
The eyelid specialists at Ticho Eye Associates offer several treatment options to safely address drooping and puffy eyelids while maintaining a natural-looking appearance.
What is Dermatochalasis?
Dermatochalasis refers to the excess, thin, redundant eyelid skin which occurs naturally with age. Severe or repeated eyelid swelling can also lead to excess eyelid skin folds. In addition to giving a tired and heavy or “hooded” appearance to the eyelids, dermatochalasis can impair makeup application and occasionally causes enough drooping to impair vision.
In upper blepharoplasty, the excess skin of dermatochalasis is removed, though an eyelid crease incision which effectively hides surgical scarring when the eyes are open. If the sagging upper eyelid skin impairs the superior visual field, blepharoplasty may be considered functionally indicated and may be covered by insurance. Both upper and peripheral vision may be improved by upper blepharoplasty, improving awareness of one's surroundings.
Occasionally excess orbital fat is removed, but generally, efforts are made to preserve eyelid volume, avoiding a hollowed-out appearance. By re-positioning fat and tightening lax orbicularis eyelid muscle in addition to removing the excess skin, blepharoplasty can produce a more relaxed and youthful appearance.
More complex than upper blepharoplasty, lower blepharoplasty incisions may be performed via the inner surface of the eyelid (transconjunctival approach), just below the lower eyelashes (subciliar approach), or a combination of the two. Lower eyelid fat tends to sink with gravity, accentuating the “dark circles” of the tear trough, and may benefit from repositioning. The eyelid experts at Ticho Eye Associates will perform a thorough evaluation to match each patient’s goals and unique anatomy to determine the most appropriate surgical approach. Such a personalized process is critical to achieving the natural appearance and functional benefits that create long-term patient satisfaction. To have your eyelid questions answered, please make an appointment at one of our practice locations in Chicago Ridge, IL, Tinley Park, IL, and Munster, IN.