Nerve problems — Because the eye muscles are
controlled by nerves that come from the brain,
conditions that injure the brain or its cranial nerves
sometimes can cause ptosis. These conditions include
stroke, brain tumor, a brain aneurysm (a grapelike
swelling on a blood vessel inside the brain), and nerve
damage related to long-term diabetes. Another cause of
ptosis is Horner's syndrome, which also can cause an
abnormally small pupil and loss of the ability to sweat
— on half the face. One particularly dangerous cause of
Horner's syndrome is a cancerous tumor located at the
top portion of the lungs.
Local eye problems — In some cases, an eyelid droops
because of an infection or tumor of the eyelid, a tumor inside
the eye socket, or a blow to the eye.
Doctors assess the severity of eyelid droop by taking precise
measurements of the eyelid and eye opening. You can screen for
the problem yourself by looking straight ahead in a mirror. As
you look at your eye, a sizable part of your iris (the eye's
colored circle) should be visible above your pupil, and no part
of the pupil itself should ever be covered by the eyelid.
If you have ptosis, the drooping eyelid narrows your eye's
opening, which makes your affected eye appear smaller than
normal. You also may lose the crease (fold of skin) that
normally lies between your upper eyelid and eyebrow. If ptosis
covers your pupil and limits your vision, you may try to
compensate unconsciously by raising your eyebrows. This can
cause tension headaches and give your eyes an odd, surprised
appearance. You also may tilt your chin up and look down your
nose as a way of seeing out from under your eyelid's lower
Other symptoms of ptosis include a decreased ability to keep
your eyes open, eye strain from the increased effort needed to
raise your eyelids, and fatigue, especially when reading.
In severe cases, it may be necessary to tilt your head back or
lift the eyelid with a finger in order to see out from under the
droopy eyelid(s). You may also complain that your eyelids have a
tired appearance from "droopy eyelids" even though you are well
Acquired ptosis is usually treated by surgery. The surgery is
usually performed as an outpatient (there is usually no need for
hospitalization). Local anesthesia which numbs the upper eyelid
is combined with light sedation so there is little, if any, pain
during or even after the procedure. The main goals of ptosis
surgery are elevation of the upper eyelid to restore normal
field of vision and an attempt to achieve symmetry with the
opposite upper eyelid.
Ptsosis is usually due to weakness in the muscles or the nerves
of the eyelid. To effectively treat ptosis requires a special
understanding of the anatomy and pathophysiology of the eyelid.
The excellent general plastic surgeon who does tummy tucks and
breast augmentations almost never has been trained in eyelid
anatomy or pathophysiology and should NOT be the one you choose
to treat your ptosis, which should be treated only by a fully
fellowship trained oculo-facial surgeon. Fellowship in the
American Society of Oculofacial Plastic and Reconstructive
Surgery (ASOPRS) indicates that the surgeon has greatest
specialized training and expertise in this subspecialty.
If the droopy eyelid is interfering with vision, the cost of the
surgery may be covered completely or partly by your medical
If you have ptosis, please consult with Dr. Kass who is fully
trained to treat this problem and has been in practice in Tampa
Bay for over 27 years.