In this Consultant Q&A, Ophthalmic and Oculoplastic Surgeon Mr Raman Malhotra dives into the eye condition ptosis - drooping of the upper eyelid. Watch the full video as he explains how to recognise ptosis and highlights common and rare causes.
He also explores the treatment options available and why the technique used can depend on the cause of the ptosis.
Q1. Do I have ptosis?
A. One of the interesting things about ptosis is I think that it's present in everyone over the age of 50.
The simplest thing you can do is to look at your photos when younger and if you had a more open eye than you do now, then the likelihood is that you have ptosis and it's worth correcting that at the same time as an upper blepharoplasty. One thing we're taught in surgery is when you are considering upper blepharoplasty is not to miss ptosis. The good thing about all the plastic surgeons that I work with here at The McIndoe Centre is that they are very good at making sure they don't miss ptosis. And if you don't correct ptosis at the time of an upper blepharoplasty, you are missing a trick because what it causes is a heavy eyelid, a tired eye, something that perhaps feels worse in the evening, you're raising your brows to compensate, so, then you get lines on your forehead so, you may see someone for Botox for that.
Q2. What are the causes of ptosis?
A. I think the majority of causes of ptosis that I would see are going to be age related. Contact lens wearers get it more than non-contact lens wearers, and I don't know why it is; maybe it's the stretching of the eyelid or the rubbing of the contact lens underneath the eyelid. And you can be born with it, it's quite subtle when it's mild. And then there are also some rare neurological causes which are important medically not to miss because they can actually represent some serious conditions. But by and large, the majority are going to be due to age and contact lens wear.
Q3. Treatment options for ptosis
A. So, you've established that you've got ptosis, how do you treat it? Majority are going to be surgery, and when it's a simple age related or contact lens related ptosis, then you simply have to reattach the muscle that lifts your eyelid. It comes from behind the eye, it's called the levator muscle. Think of it as the elevator muscle and that just simply needs to be reattached.
In rare situations, you may have to shorten the muscle because it doesn't work so well.
And in even rarer situations, you may have to suspend the eyelid from the brow because that muscle just doesn't move at all. But in the majority of situations, it's a case of reattaching the muscle to the eyelid.
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