Droopy Eyelids

Droopy Eyelids (眼皮下垂) – What You Should Know

Introduction

Droopy Eyelids can make one look sleepy, inattentive, or even angry and grumpy. It can in more severe cases, block our line of sight. Secondarily, as a result of a subconscious effort to elevate the lids, patients present with excessive forehead frown lines, and may even complain of fatigue as a result of continued attempts to raise their upper eyelids to compensate for the droopy lids blocking their line of sight.

Ptosis of the eyelids, otherwise known as droopy eyelids, is commonly due to a weakness of the muscle that raises the upper eyelid. There are other causes, which are much less common (such as nerve disease-third nerve palsy or a problem at the neuromuscular junction between the nerve and the muscle-myasthenia), but the majority of the conditions are age related. With increasing age, the cumulative effects of gravity, ‘wear and tear’, and rubbing (over a prolonged period) contribute to a stretching of the muscle complex, giving rise to ptosis.

Prolonged usage of contact lens usage is also a well-recognized cause of ptosis. 

How Patients Present

Patients with ptosis complain that the droopy lid or lids make them look sleepy or angry, block their vision (especially the upper half of the visual field), or cause them headaches or tiredness as they try to compensate for the condition by using their brows to lift up the eyelids.

Occasionally, it may be their relatives or friends that notice the droopy eyelids and bring it to the attention of the affected.

Broadly, the condition can be congenital or acquired. The most accepted classification is based on the structure affected viz. neurogenic (the nerve to the muscle), myogenic (the levator muscle itself is malformed at birth in congenital ptosis), aponeurotic (the sheet connecting the muscle to the eyelid plate, which becomes stretched or disinserted with age, the most common type), and others.

How Ptosis is managed

Treatment is targeted at the cause, and frequently involves surgery (exception being myasthenia gravis, a neurological condition which can be treated with medication, and which is diagnosed with a thorough consultation), and is usually highly successful.

Ptosis surgery restores both function and appearance to the patient and as such, in the Singapore context, patients can use Medisave for the procedure because it is medically necessary. In patients who are insured, the majority (exception being congenital ptosis) will be reimbursed through their coverage plans.

Ptosis surgery is performed under regional anaesthesia so that adjustment and titration is possible. Downtime is one to two weeks, and the wound corresponds to where the double eyelid crease is. Stitches are removed after one week, and the patients will be applying medication to the wound for one to two weeks after the procedure.

Conclusion

Many patients afflicted with the condition do not seek medical help as they are often wary that others may perceive them as vain or are under the impression is purely a cosmetic issue. The aim of this article is to shed light on the condition so that patients need not suffer in silence and take appropriate action to rectify their problem.