There are two common eye lid condition known as "droopy eyelid" One is called ptosis, where there is an abnormality of the upper eyelid muscle. The other is called pseudo-ptosis or dermatochalasis, where there is excess sagging upper lid skin. These conditions can exist together and often required more extensive surgical treatment.

PTOSIS

Ptosis causes an upper eyelid droop where the eyelid covers part of the eye, impairing the vision and the superior field of vision. It can have many causes including age, injury or nerve malfunction. It can also occur at birth.

Age is the most common cause of ptosis. The muscles that elevate the eyelid become thinned, resulting in a loss of muscle tone and the inability to hold the upper lid in the proper position above the eye.

Injury is another common cause of ptosis. Patients who suffer traumatic injuries to the eye can sustain damages to the delicate eyelid structures, resulting in secondary ptosis. Sometimes ptosis can be noticed at birth. In these cases it is due to an abnormality in the development of the muscles that elevate the upper lid. Three-quarters of the time it affects only one eye. In newborns, this problem must be addressed and treated properly to insure normal maturation of the visual system and the avoidance of amblyopia (lazy eye).

Ptosis can also be caused by a malfunction of the nerves which control and activate the eyelid muscles. These cases are rare and proper diagnosis is important in order to avoid unnecessary surgery. When a neurological disorder is present, symptoms typically include visual complaints independent of the droopy eyelid. Difficulty reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well.

The most common treatment for ptosis is surgical, and there are a number of possible approaches. The goal is to tighten the muscles so that the lid is elevated to match the lid on the other side, but with a minimum of scars and side effects. One possible complication is that the muscles can be over tightened. This results in the inability to close the eye completely after surgery. Such a situation creates a dry eye condition that needs to be treated.

In the age-related form, both eyelids may be drooping, but only one is low enough to require surgery. Almost invariably in these cases, the unoperated eyelid will appear lower after a successful repair of the first eye. In these cases, the second eye will eventually require surgery.

DERMATOCHALASIS

Dermatochalsis is a age-related condition where the excess upper eyelid skin droops down and interferes with the patients superior field of vision. The eyelid muscle usually functions well. Some people call eyes with this condition "baggy eyes." The excess sagging upper lid skin can become symptomatic.

Excess upper lid skin sags and creates a hooding effect

The usual treatment for symptomatic dermatochalasis is a blepharoplasty procedure, which is a surgical excision of the excess skin and some of the underlying fat tissue.