What is the treatment for a droopy eyelid (ptosis)?

Treatment for Droopy Eyelid (Ptosis)

Surgical correction is the definitive treatment for ptosis, with the specific technique determined by the severity of ptosis and levator muscle function. 1

Evaluation and Classification

Before determining treatment, proper evaluation is essential:

• Determine severity of ptosis:

  • Minimal: 1-2 mm drooping
  • Moderate: 3-4 mm drooping
  • Severe: >4 mm drooping (may cover pupil entirely) 1

• Assess levator muscle function (critical for surgical planning)

• Rule out urgent causes requiring immediate attention:

  • Pupillary abnormalities (myosis suggesting Horner's syndrome, mydriasis suggesting aneurysm)
  • Daily variation suggesting myasthenia gravis 2
  • Involvement of other facial muscles or neurological symptoms 3

Treatment Algorithm

1. Non-surgical Management (For Temporary Relief)

• For mild cases or when surgery is contraindicated:
  • Preservative-free ocular lubricants to manage associated dry eye 4
  • Eyelid taping or protective shield while sleeping (especially for floppy eyelid syndrome) 4
  • Topical antihistamine eyedrops if inflammatory component present 4

2. Surgical Management (Definitive Treatment)

Surgical approach based on severity and levator function:

• Minimal ptosis with good levator function (>10mm):

  • Müller's muscle conjunctival resection
  • Fasanella-Servat procedure 1

• Moderate ptosis with fair levator function (5-10mm):

  • Levator palpebrae shortening
  • Levator muscle advancement 1

• Severe ptosis with poor levator function (<5mm):

  • Frontalis suspension/brow suspension 1

Special Considerations

• Congenital ptosis: Early surgical correction is important to prevent amblyopia 1

• Neurogenic ptosis: Address underlying neurological condition first 2

• Myasthenia gravis: Medical management with pyridostigmine before considering surgery 3

• Floppy eyelid syndrome: May require lateral canthus repair, horizontal shortening of upper eyelid, or excision of medial upper lid 4

• Giant fornix syndrome with ptosis: Surgical correction of ptosis may be helpful after treating underlying infection 4

Potential Complications of Surgery

• Infection or bleeding (uncommon)
• Over- or under-correction
• Temporary difficulty closing the eye completely
• Asymmetry between eyelids
• Rarely, incomplete recovery of full eyelid movement 1

Follow-up Care

• Regular follow-up to assess surgical outcome
• Management of dry eye or exposure keratopathy if present
• Multiple operations may be required in some cases 1

For most patients with ptosis, surgical intervention provides the best long-term outcome for both functional and cosmetic concerns, with the specific technique tailored to the severity and underlying cause of the condition.