A droopy eyelid or ptosis can be present at birth (congenital) or occur later in life (acquired). Poor development of the levator palpebris muscle in the upper eyelid with resulting abnormal function is the most common cause of congenital ptosis. Acquired ptosis has many causes. Ptosis can involve one or both upper eyelids, with or without asymmetry.
One or more of the following vision problems may accompany ptosis in childhood: astigmatism (refractive error), obstruction of the visual axis, chin up head position, and amblyopia. The abnormal resting position of the eyelid on the cornea may result in astigmatism or other refractive error and is a risk factor to develop amblyopia. Another risk factor for amblyopia is an eyelid so droopy that it actually blocks vision into the eye. Also, a chin up head position to see below the droopy eyelid may be noted. Contraction of the frontalis muscle (in the forehead) to help elevate the eyelid is a very common compensatory mechanism.
Acquired ptosis can be caused by neurological conditions that affect the nerves and/or muscles of the eye. These include myasthenia gravis, progressive external ophthalmoplegia, Horner syndrome and third nerve paralysis. The ptosis may be combined with an eye movement disorder/ double vision. An eyelid mass can also cause ptosis.
The Eye M.D. typically inquires as to the time of onset, variability, and presence/absence of double vision which may aid in determining the cause of the ptosis. A complete eye examination is performed with special attention given to the eyelid position, vision assessment, refraction and the head position. Special tests such as radiographic exams are not commonly ordered.
When amblyopia is present, appropriate treatment is initiated. When potential amblyopia causing astigmatism is present, glasses are often prescribed. Early surgery is usually indicated for a droopy eyelid that blocks vision (which may cause delayed vision development) or causes a chin up head position (which may cause neck problems and/or delay of developmental skills). Children are usually observed serially to monitor for visual problems. During preschool years surgery may be indicated if facial maturation has not sufficiently improved the ptosis.