Generally, there are 2 causes of drooping eyelid(s): ptosis and dermatochalasis

Both cause the rim of one upper eyelid to rest at a lower position than normal, and may affect only one or both eyelids.

Drooping eyelid(s) caused by ptosis can be classified into 2 main groups:

1. Drooping caused by eyelid nerve abnormalities; this usually causes the eyelid(s) to droop at certain times, for instance, only in the afternoon. It is able to be controlled through medication, although patients must remain under a neurologist’s supervision.
2. Drooping caused by eyelid muscle abnormalities; this includes drooping due to congenital abnormalities, physical trauma, blepharitis, or weakness of the eyelid muscles.

The other condition, dermatochalasis, is the presence of excess skin in the upper (or lower) eyelid. It leads to the reduced elasticity of the upper eyelid muscles and causes the skin to stretch and droop down. This condition is due to genetics and increasing age. It is generally found in patients aged 60 and over, and becomes more prevalent as the patient’s age increases.

Symptoms of both ptosis and dermatochalasis are generally similar – the eyelids cause visual field obstruction. Patients often have aching pains in their upper eyelids and may have difficulty opening their eyes, some people may even have to raise their eyebrows high to open their eyes and see.

The ophthalmologist must first assess the patients’ overall health and diagnose the actual cause of the drooping. This ensures that the correct treatment is given, and helps to protect against any possible complications resulting from either the treatment itself or other illnesses the patient may have.

Either condition can be treated with blepharoplasty, in which the doctor surgically removes excessive skin and fat from the eyelid, before stitching the wound so that both eyelids rest at an equal height and appear natural. The procedure relies heavily on the expertise of the surgeon, as the skin on and around the eyelid(s) is especially delicate, and does not allow for additional surgeries.

The procedure takes approximately 1 hour per eye to complete. Patients may choose to be given either general anesthesia, IV sedation, or local anesthesia. After surgery, patients are required to rest before returning home the same day.

Eye patches or gauze is not necessary. However, patients will experience swelling and bruising – with intense swelling within the first week after surgery. Once the stitches are removed, swelling will improve and return to normal within 1-2 months. Patients must clean with their wound with saline solution in the mornings, evenings, and before bedtime, and should also do their best to avoid getting the wound wet. Medications should be taken as prescribed by the doctor.

Patients should also avoid activities which cause eye strain as much as possible for the first 1-2 weeks in order to prevent dry eyes; avoid using a computer, reading, or staring at a smartphone for long periods of time. Dark glasses should also be worn throughout the day, as they will protect not only against bright light but also against dust and wind.

As the eyelids are incredibly delicate, ptosis, along with other eyelid conditions, must only be treated by an ophthalmic plastic and reconstructive specialist or oculoplastic specialist.