Eyelid Ptosis

Upper eyelid ptosis is a very common condition among Asian patients. It is prevalent in aging Caucasian patients as well. Often these patients present with a droopy upper eyelid on one or both sides which results in vision obstruction. There are multiple etiologies for this condition. The muscles, which are mainly responsible for elevating the upper eyelid, are the levator palpebrae superioris, the Muellers muscle, and the frontalis muscle in the forehead. The forehead muscle is merely an accessory muscle, and plays a minor role in elevation of the upper lid. The two main muscles, the levator and the mueller’s muscles, are critical in proper function of the upper eyelid.

If the levator muscle is stretched out or loose, as in aging patients upper lid, there will be some degree of ptosis. In addition, if the levator has limited movement, as in Asian patients, there will be ptosis. The second muscle, called Mueller’s muscle, which is under involuntary control (autonomic nervous system), can contribute to ptosis. Patients with nerve injury or Bell’s palsy can have upper eyelid droop.

Regardless of the cause of upper eyelid ptosis, the surgical repair is the same. By tightening, or advancing, the levator muscle, ptosis can be improved markedly. The upper lid function can be restored. The upper lid appearance can be normal. The upper eyelid crease can also change when the levator is operated on. With upper lid ptosis, the upper lid crease will appear very unnaturally large. By fixing the muscle, the crease returns to a more natural size. This surgical repair can be done on either one or both sides.

The forehead wrinkles, which results from the forehead muscle contracting (frontalis), can be much improved by fixing the ptosis. When the upper lid opens properly the forehead muscle is no longer needed to open the eyes. The forehead muscle will then rest when the upper lid opens the eye and the forehead wrinkles disappear.