There’s More to a Sagging Eyelid than Meets the Eye

November 1, 2021

In our September 8th blog, we shared the story of how Atlantic Eye’s Dr. Ronald Kristan made a lifesaving decision for patient Lisa Economou (September blog). In this season of giving thanks, we remember Lisa’s gratitude for Dr. Kristan’s care. Let’s explore the common eye disorder that brought Lisa to us just in time: droopy eyelid(s), known as ptosis.

Types of Ptosis:
Ptosis is caused by a weakening or malfunctioning of the levator muscle, which lifts the eyelid. There are two broad categories: congenital ptosis, which is present at birth, and acquired ptosis when the condition develops later in life. Acquired ptosis is more common.

Congenital
In congenital ptosis, the levator muscle doesn’t develop properly in the womb, so the child is born with compromised or little levator muscle function. As a result, children born with ptosis often have limited vision and may tilt their heads back in order to try to see properly. If the ptosis is severe enough, it can cause amblyopia (lazy eye) or astigmatism. It is important to treat at a younger age—if left untreated, it could affect vision development.

Acquired
Five main types of acquired ptosis can develop throughout a lifetime:

  • Aponeurotic ptosis is the most common type. It may develop if the levator muscle becomes overstretched, usually due to aging. Excessive eye rubbing, eyelid pulling, or long-term contact lens use can also cause the condition.
  • Neurogenic ptosis results from a problem with the nerve pathway that controls the movement of the eyelid muscles. Causes of neurogenic ptosis include myasthenia gravis, third nerve palsy, and Horner syndrome.
  • Myogenic ptosis is due to a systemic disorder that causes levator muscle weakness. Causes may include chronic progressive external ophthalmoplegia and types of muscular dystrophy.
  • Mechanical ptosis is when the eyelid is weighed down by excessive skin or a mass.
  • Traumatic ptosis is caused by an injury to the eyelid that compromises or weakens the levator muscle.

Fortunately, ptosis can usually be treated with medication or, when indicated, surgery. In Lisa’s case, her ptosis turned out to be an indicator of a serious medical issue, but this is a rare occurrence.

At Thanksgiving and all year long, AE physicians thank our patients for trusting us to help them maintain their best vision. We are committed to serving your eye health needs with vigilance and caring. Please call with questions or to schedule an appointment, (732) 222-7373.