Droopy eyelids: Correction of sleepy eyes

October 23, 2016

What is eyelid ptosis?
Ptosis of the eyelid (blepharoptosis) is diagnosed when the eyelid position (eyelash margin) is abnormally low, covering a few millimetres of the black of the eye (cornea).
This is due to the weakness of the eyelid lifting (levator) mechanism. Patients with droopy eyelids give the impression of being sleepy all the time. This can affect their self-esteem.

Is ptosis similar to ageing eyelids?
With ageing, the upper eyelid skin can become excessive and droop in front of the eyelash margin. This condition is called dermatochalasis.
It must be differentiated from ptosis because the ageing excessive eyelid skin can also cover part of the cornea but the eyelash margin may not be droopy (see diagrams). True ptosis and dermatochalasis can co-exist. In this instance, both can be corrected together.

What causes ptosis?
It can be caused by ageing, trauma, nerve injury etc. The condition can be congenital or in-born.

What is the treatment of ptosis – is it different from conventional upper lid surgery?
The best treatment of ptosis is surgical correction. There is no reliable non-surgical method to manage ptosis.
Your doctor can evaluate the severity of ptosis and status of the eyelid’s levator function (residual lifting ability of the lid). These two parameters will determine the type of surgery needed, for example levator plication, levator advancement, frontalis suspension, FOOM flap etc.
These surgeries are much more time-consuming and difficult to perform than the usual upper lid surgery which trims excessive skin and fat. The surgical correction of ptosis requires careful and elaborate repair of the inner lifting mechanism of the upper lid.

Who can treat ptosis?
Plastic surgeons and a subgroup of eye specialists treat ptosis. Most patients would probably have higher expectations of the plastic surgeon as he or she is expected to correct the functional ptosis problem and concomitant issues e.g. excessive upper lid skin, eyelid asymmetry and sunken lids.

Can I use Medisave or insurance to make a claim for treatment of ptosis?
Moderate to severe ptosis is considered a medical condition and treatment may be eligible for Medisave and insurance claims.
However the Ministry of Health has very strict guidelines and would advise the condition to be confirmed by an eye specialist. The patient can then undergo surgery with either the plastic surgeon or eye specialist.