Ptosis: All You Need To Know About Drooping Eyelids

Example of ptosis concerns prior to surgery


Ptosis, also known as blepharoptosis, refers to the drooping or lowered position of the upper eyelid. Ptosis or drooping eyelids can cause one to appear more tired and may affect one’s self-esteem. When more severe, ptosis can impair one’s superior visual field. In the case of children with congenital ptosis, a severe droop can lead to poor development of the visual pathways in the brain and result in ‘lazy eye’ or amblyopia.


Definition of ptosis

Ptosis is assessed by measuring the marginal reflex distance, which is the distance between the upper eyelid margin and the reflection in the centre of the pupil. Ptosis is defined when the distance between the light reflex in the eye’s centre and the upper eyelid is less than 2mm. This is in contrast to a standard upper eyelid margin of about 3 to 4mm from the centre of the pupil.


Symptoms of ptosis

The most apparent symptom of ptosis is the drooping of one or both eyelids. The degree of droop varies from patient to patient. Those with ptosis tend to compensate for the droop by lifting their chin upwards and raising their eyebrows so that they can see better. This can lead to periocular and neck strain.


Ptosis in children

Congenital ptosis, seen in affected children at birth, is caused by poor development of the levator palpebrae superioris (LPS) muscle which lifts the eyelid. Children with congenital ptosis are at higher risk for vision problems. Should the eyelid droop be so severe that it blocks vision, it can lead to poor development of the visual pathways in the brain with poor vision on that side. This condition cannot be corrected with spectacle wear and is known as amblyopia (or ‘lazy eye’). Congenital ptosis can also be linked to higher degrees of astigmatism. If your child has a droopy eyelid, it is recommended to seek expert advice to ensure normal development of vision.


Ptosis in adults

Ptosis in adults is much more common and is most frequently due to degenerative changes within the eyelid, causing the diminished function of the levator muscle. In this situation, the levator muscles are stretched or become separated from the tarsal plate portion of the eyelid that is located at the lash-bearing area. This is known as aponeurotic ptosis and some risk factors include increasing age, eye injury or previous eye surgery, frequent eye rubbing as well as previous contact lens wear. Aside from degenerative causes, ptosis in adults may be due to neurological conditions including myasthenia gravis. In this latter condition, only medical treatment may be required.


Treatment for ptosis

If the condition is severe or bothersome enough, you may wish to consider an eyelid ptosis correction surgery in Singapore There are different considerations for ptosis repair surgery in children and in adults.


Congenital ptosis:

Surgery may not be recommended for children with congenital ptosis if the condition is mild and there is a low risk of poor vision development. For those who require surgery to ensure good vision development and in whom the levator muscle still shows reasonably good function, levator resection may be employed. In this procedure, the LPS is shortened to achieve the lift. In more severe cases of congenital ptosis where the levator function is poor, frontalis suspension surgery is used. This involves the use of a sling to connect the eyelid to the frontalis muscle above the brow. These surgeries, however, come with some trade-offs in that the patient will not be able to close the eye fully and the upper lid will appear elevated in downgaze. It is best to consult a specialist to know what to expect after congenital ptosis surgery.


Adult ptosis:

The most common type of ptosis in adults, aponeurotic ptosis, is readily correctable with surgery. The surgery is performed with the patient awake but under mild sedation. Downtime is generally expected to be between 1 to 2 weeks.

Technically, ptosis repair surgery involves reattaching (with or without shortening of) the LPS to the tarsal plate. This helps improve the upper lid lift and clears the superior visual field. Unlike congenital ptosis repair, there are no concerns about long-term poor eye closure or elevated upper lid position in downgaze as the LPS muscle is a normally-developed muscle. Indeed, ptosis repair surgery is often mistaken for aesthetic surgery as there is an overall pleasing improvement in the eye appearance after ptosis repair surgery.



When symptoms of ptosis arise in yourself or your child, it is recommended that you consult an eye specialist doctor who can assess the severity of your condition and provide you with advice on the appropriate treatment. If you are experiencing symptoms or notice them in your loved ones, seek clarification by booking an appointment with us at Ava Eye Clinic.


Ptosis: All You Need To Know About Drooping Eyelids

Note: Post-operative results in Singapore can only be viewed during a consultation