A droopy upper eyelid is called "ptosis." It may affect one eye or both eyes. Ptosis may be congenital (present at or shortly after birth), or it may develop later in life.

When mild, ptosis may only be a cosmetic concern. When more severe, however, it may cover the pupil and result in significant interference with vision.

Treatment usually involves removing excess skin weighing down the eyelid in addition to tightening the lax muscles and tendons to lift the eyelid. Surgery is typically done in the office under local anesthesia, but can also be done in the operating room with the patient lightly sedated.

Congenital ptosis results from an improper development of the levator muscle responsible for raising the eyelid. Children with this disorder may also show some degree of strabismus (where the eyes are not properly aligned), amblyopia ("lazy eye," where vision is reduced in the eye with ptosis), and a cosmetically undesirable appearance.

The treatment of congenital ptosis depends upon the degree of ptosis and on the associated findings. If mild and only of cosmetic concern, surgical correction should be performed between three and five years of age, before the child begins school. When more severe and interfering with vision, the repair must be performed at an earlier age to allow normal vision development.

Surgery usually involves tightening of the levator muscle to elevate the drooping eyelid. In severe cases where the muscle is very weak, a "sling" procedure may be needed to allow the forehead muscles to help lift the eyelid.

In acquired ptosis, the levator muscle is usually normal, but most often the tendon between the muscle and the eyelid is stretched. This may happen following eye surgery, such as for a cataract, or as a result of normal aging. It may also be seen following trauma with injury to the levator muscle, its tendon, or its nerve. Acquired ptosis may be of cosmetic concern only, or it may result in loss of the upper visual field.

Acquired ptosis is treated surgically, with the specific operation based on the severity of the ptosis and the remaining strength of the levator muscle.

Learn more about oculofacial surgery:

• Entropion and Ectropion of the Lower Eyelid
• The Tearing Eye
• Eyelid Cancers
• Blepharoplasty

Duke Eye Center offers treatment for ptosis of the upper eyelid at locations near Durham, Raleigh, Cary, and other areas of North Carolina.