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(Drooping eyelid (ptosis

What is ptosis?

Drooping of the upper eyelid is referred to as ptosis, which may be slight or cover the whole pupil. In some cases, ptosis can partially obstruct or fully block the normal sight. Ptosis can:

  • Involve one or both eyes
  • Be hereditary
  • Occur at birth
  • Occur in later years

Ptosis in children:

Congenital ptosis means presence of ptosis at birth. If a child is born with moderate to severe ptosis, he may require immediate treatment for normal visual development.

Congenital ptosis often occurs due to defective development of upper eyelid lifting muscle, called levator muscle. Although it is usually an isolated impairment, in congenital cases, it may be associated with the following impairments:

  • Eye movement disorder
  • Muscular diseases
  • Eyelid tumors or other tumors
  • Neurological disorders
  • Refractive errors

Congenital ptosis does not improve with time.

What are signs and symptoms of ptosis?

The most common and obvious sign in children’s ptosis is drooping of the eyelid. In congenital ptosis, there is usually asymmetry between the upper eyelid creases. Children with ptosis may have to bend their necks backward, or push their eyebrows upward to see. These head and facial maneuvers indicate that the child is trying to use both eyes to see. After a few years, these abnormal head positions may lead to head and neck deformities.

What problems result from ptosis in children?

Amblyopia (lazy eye) is the most serious disorder associated with childhood ptosis. Ptosis can cause amblyopia for two reasons:

  • Obstruction of sight in severe cases
  • Astigmatism and subsequent blurred vision

In addition, ptosis may hide possible crossed eyes (strabismus), which can lead to amblyopia.

How is congenital ptosis treated?

In most cases, children’s ptosis is treated with surgery. However, if it is accompanied by amblyopia, treatment may involve patching the healthy eye, use of glasses, or eye drops. Indication of surgery and choosing the right option is decided according to the following factors:

  • The child’s age
  • Involvement of one or both eyelids
  • Intensity of ptosis
  • Strength of lifting and closing eyelid muscles
  • The eye movement status

Normally, in early life, surgery is not indicated in mild to moderate cases of ptosis. Both the above (mild and moderate) and severe cases that have undergone surgery should regularly be examined by an ophthalmologist for amblyopia, refractive errors, and associated conditions, and undergo treatment if necessary.

What causes ptosis in adults?

The most common cause of ptosis in adults is stretching or separation of levator muscle from the eyelid. This may occur due to the following:

  • Aging
  • Following cataract or other eye surgeries
  • After eye trauma

Adult ptosis may also occur due to complications from other diseases such as: neurological or muscular diseases, and tumor of the pupil in rare cases, which involves levator muscle or its nerve.

How is adult ptosis treated?

An ophthalmologist can comprehensively examine the problem and provide necessary information on various treatment options, potential complications and risks.

To diagnose causes of ptosis and choose the best treatment method, blood test, special x-rays, and other tests may be required. First, the underlying cause should be treated (if found). However, in most cases, the ultimate treatment is surgery. Type of surgery depends on severity of ptosis and other clinical findings.

What are the risks of ptosis surgery?

The risks of ptosis surgery include infection, bleeding, and reduced vision, but these complications occur very rarely. The eye may not fully close immediately after surgery, but this is normally temporary. During this time, protective eye drops or ointment may be used. Although eyelid appearance is significantly improved, eyelids may seem asymmetric. In most cases, when looking down, the operated eyelid may stay slightly higher than the opposite eyelid. It may also remain ajar at nights; these two complications are not problematic. In rare cases, full eyelid movement cannot be restored. In some cases, surgery may be needed more once.


In both adults and children, ptosis can be treated with surgery. In addition to improving appearance, surgery can improve eye-sight. In children’s ptosis, regular eye examination in early years of life is particularly important to prevent and treat potential amblyopia.