Ptosis

Ptosis (pronounced "toe-sis") refers to the abnormal drooping of the upper eyelid. When the eyelid muscles weaken or become disinserted, the eyelid descends, potentially obstructing vision.

The most obvious symptom is a drooping eyelid, which may affect one eye (unilateral) or both eyes (bilateral).

Patients with ptosis may also find themselves unconsciously lifting their eyelids with their brow muscles, which can lead to headaches, eye strain, and fatigue by the end of the day. In severe cases, the eyelid may completely cover the pupil, significantly restricting vision.

When you visit us at Sutherland Eye Surgeons, some of the tests that we perform may include:

• Visual acuity testing
  Assessment of your best corrected vision

• External eyelid examination
  Evaluation of eyelid position, symmetry, and the presence of any associated conditions such as dermatochalasis (excess skin) or brow ptosis (drooping eyebrows)

• Measurement of eyelid position
  Including the Margin Reflex Distance (MRD), which measures the gap between the light reflex on the cornea and the upper eyelid margin. An MRD of 1 mm or less often indicates significant ptosis

• Levator function assessment
  Measurement of eyelid excursion to determine the strength of the levator muscle. This guides the choice of surgical technique

• Slit lamp examination
  Assessment of the ocular surface, cornea, and conjunctiva for signs of exposure or irritation

• Visual field testing
  Formal perimetry with the eyelid in its natural position and with the eyelid taped up. This demonstrates the degree of functional obstruction and may be required for Medicare rebate eligibility

• Photographic documentation
  Baseline photographs to document the degree of ptosis and monitor for progression

• Fatigue testing
  If myasthenia gravis is suspected, your specialist may test for improvement in ptosis with rest or following ice application

• Neurological evaluation
  If neurogenic ptosis is suspected, further assessment of pupillary responses and extraocular movements may be performed

The goal of ptosis repair is to elevate the eyelid to a normal position, restoring symmetry and expanding the visual field. The specific technique depends on the type and severity of ptosis, as well as the strength of the levator muscle.

Where brow ptosis contributes to the droop, a brow lift may be performed concurrently. If excess upper eyelid skin is also present, combined ptosis repair and blepharoplasty can address both function and appearance. When excess skin alone is obstructing the visual field and meets Medicare criteria, upper lid blepharoplasty may be performed on its own, typically bilaterally to ensure symmetry. Most patients experience significant improvement in both vision and appearance following surgery.