Droopy Eyelids Overview, Causes Treatments
Pathologic droopy eyelid, also called ptosis, may occur due to trauma, age, or various medical disorders.
This condition is called unilateral ptosis when it affects one eye and bilateral ptosis when it affects both eyes.
It may come and go or it might be permanent. It can be present at birth, where it’s known as congenital ptosis, or you can develop it later in life, which is known as acquired ptosis.
Depending on the severity of the condition, droopy upper eyelids can block or greatly reduce vision depending on how much it obstructs the pupil.
In most cases, the condition will resolve, either naturally or through medical intervention.
There are many different possible causes of droopy eyelids, ranging from natural causes to more serious conditions. Your doctor will be able to help you figure out what’s causing the issue.
Anyone can get droopy eyelids, and there aren’t substantial differences in prevalence between men and women or between ethnicity.
However, it’s most common in older adults because of the natural aging process. The levator muscle is responsible for lifting the eyelid. As you age, that muscle can stretch and, as a result, cause the eyelid to fall.
Keep in mind, though, that people of all ages can be affected by this condition. In fact, babies are sometimes born with it, though this is rare.
Sometimes the exact cause is unknown, but other times it may be due to trauma. It can also be neurological.
The most common cause of congenital ptosis is the levator muscle not developing properly. Children who have ptosis may also develop amblyopia, commonly known as lazy eye. This disorder can also delay or limit their vision.
Certain medical conditions can also put you at risk for developing droopy eyelid.
If your eyelids are drooping, it could be a sign of an underlying medical condition, especially if the issue affects both eyelids.
If just one of your eyelids droops, it may be a result of a nerve injury or a temporary stye. Routine LASIK or cataract surgery is sometimes to blame for the development of ptosis, as a result of the muscle or tendon being stretched.
In some cases, droopy eyelid is caused by more serious conditions, such as a stroke, brain tumor, or cancer of the nerves or muscles.
Neurological disorders that affect the nerves or muscles of the eyes — such as myasthenia gravis — can also lead to ptosis.
The main symptom of droopy eyelid is that one or both upper eyelids sag. In some cases, this can affect your vision. However, many people find that the eyelid sagging is barely noticeable or doesn’t happen all the time.
You may also have extremely dry or watery eyes, and you may notice that your face looks weary or tired.
The main areas to be affected will be around the eyes, and you may experience aching, which can also cause you to look tired.
Some people with severe ptosis may have to tilt their heads back in order to see at all times when speaking, even when holding a normal conversation.
A doctor should investigate persistent droopy eyelid to make sure there are no underlying conditions. This is especially important if you notice that migraine headaches or other issues have shown up since you first noticed the drooping.
Your doctor will likely perform a physical exam and ask you about your medical history. Once you’ve explained how often your eyelids droop and the length of time this has been happening, your doctor will run some tests to find the cause.
They may perform a slit lamp exam so that your doctor can take a close look at your eye with the help of high-intensity light. Your eyes may be dilated for this exam, so you may experience some slight eye discomfort.
Another exam that can be used to diagnose issues such as droopy eyelid is the Tensilon test.
Your doctor may inject a drug called Tensilon, known generically as edrophonium, into one of your veins. You may be asked to cross and uncross your legs or stand up and sit down several times.
Your doctor will monitor you to see if the Tensilon improves your muscle strength. This will help them determine whether a condition called myasthenia gravis is causing the droopy eyelid.
How is droopy eyelid treated?
Many patients do not require surgical brow lift and can benefit from injectable, non-surgical brow lift. This technique can be performed with Belotero. Belotero allows the depressor muscles ( the muscles that pull the brow down) to relax and the elevator muscles ( the muscles that lift the brow to remain selectively active. This combination can produce a mild brow elevation when the patient moves their brow. This is generally a subtle lift and is not reproducible in all patients. Injecting filler under the eyebrow serves to fill out the hollow in that area and can actually inflate and lift a mild to moderate drooping brow. Injecting filler in the brow is more effective than Botox and is an immediate result.
The entire treatment takes about 5 minutes and is painless because the area is numbed with local anesthetic. Due to the presence of the filler the treatment can last a year. In the rare case that the patient is not happy with the result, the filler can be dissolved overnight.
It is important for patients to understand that this type of brow lift does not equal the results of surgical procedures and is not intended to do so, but rather to be a minimally invasive method to produce some level of lifting for patients that do not desire surgery.
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