Congenital vs Acquired Eyelid Ptosis: What to Know

Eyelid ptosis, or droopy eyelids, is a condition that can affect both children and adults. It occurs when the upper eyelid droops lower than its normal position, sometimes covering the pupil and interfering with vision. Ptosis can be present at birth (congenital) or develop later in life (acquired) due to various factors. 

In this article, we’ll cover all the differences between this condition before going through the treatment options, so you can make an informed decision on your eye health.

What causes congenital eyelid ptosis?

Congenital eyelid ptosis is most often caused by improper development of the levator muscle, which is responsible for lifting the upper eyelid. In some cases, congenital ptosis may be associated with other eye or neurological conditions, such as Marcus Gunn jaw-winking syndrome or Horner's syndrome.

What are the common causes of acquired eyelid ptosis?

Acquired eyelid ptosis can result from several factors, including:

• Age-related weakening of the levator muscle
• Injury or trauma to the eyelid or surrounding structures
• Neurological disorders, such as myasthenia gravis or third nerve palsy
• Eyelid tumors or growths
• Previous eye surgery, such as cataract removal or LASIK

Symptoms of congenital and acquired eyelid ptosis

Symptoms of congenital ptosis

• Drooping of one or both upper eyelids, present since birth or early childhood
• Uneven appearance of the eyes
• Tilting the head back or lifting the chin to see better
• Fatigue or discomfort in the eyes or forehead due to straining to lift the eyelids

Symptoms of acquired ptosis

• Gradual or sudden drooping of one or both upper eyelids
• Reduced peripheral vision
• Difficulty reading or performing close-up tasks
• Headaches or eyestrain due to compensating for the droopy eyelid(s)
• Asymmetrical appearance of the eyes

Can congenital and acquired ptosis affect vision?

Both congenital and acquired ptosis can potentially impact vision, depending on the severity of the drooping. In congenital ptosis, the drooping eyelid may lead to amblyopia (lazy eye) if not treated promptly, as the brain may start to favor the unaffected eye. Acquired ptosis can obstruct peripheral vision and cause difficulty with reading or other near-vision tasks.

How are congenital and acquired ptosis diagnosed?

Diagnosis of eyelid ptosis involves a comprehensive eye examination and evaluation of the eyelid structure and function. Your doctor will measure the height of your eyelids, assess your levator muscle function and check for any associated eye or neurological conditions. Additional tests, such as visual field testing or neuroimaging, may be performed to rule out underlying causes or complications.

Treatment options for congenital and acquired ptosis

At Polaris Plastic Surgery, our approach to treating eyelid ptosis depends on the underlying cause and severity of the condition. Our doctors tailor the treatment plan to each patient's needs and goals.

Surgical treatments for congenital ptosis

For children with congenital ptosis, surgical correction is often recommended to improve vision and prevent amblyopia (lazy eye). The most common surgical techniques for congenital ptosis include:

• Frontalis sling surgery: This procedure involves creating a connection between the upper eyelid and the frontalis muscle in the forehead, allowing the forehead to lift the eyelid when the eyebrows are raised.
• Levator resection: In cases where the levator muscle (the muscle that lifts the eyelid) has some residual function, a levator resection may be performed to tighten the muscle and improve eyelid elevation.

Surgical treatments for acquired ptosis

For adults with acquired ptosis, surgical treatment aims to restore a more youthful, alert appearance and improve peripheral vision. The choice of surgical technique depends on the severity of ptosis and the strength of the levator muscle. Options include:

• Müller's muscle-conjunctival resection (MMCR): This procedure involves removing a small section of the Müller's muscle and conjunctiva to elevate the eyelid. It is suitable for patients with mild to moderate ptosis and good levator muscle function.
• Levator advancement: In this technique, the levator muscle is tightened and advanced to its original position, effectively lifting the eyelid. This approach is suitable for patients with moderate to severe ptosis and fair to good levator function.
• Frontalis sling surgery: For patients with severe ptosis and poor levator function, a frontalis sling procedure may be recommended, similar to the technique used for congenital ptosis.

Potential complications and risks of ptosis treatment

As with any surgical procedure, there are potential risks and complications associated with ptosis treatment. These may include:

• Overcorrection or undercorrection of the eyelid position
• Asymmetry between the eyelids
• Infection or bleeding
• Scarring or changes in eyelid contour
• Dry eye or irritation
• Temporary or permanent vision changes

Though these risks are rare, you should discuss them with your doctor, sharing any concerns you have. An experienced doctor will be able to explain all the treatment processes in detail, so that you feel secure throughout your surgery journey.

Looking for Treatment for Eyelid Ptosis?

Congenital and acquired eyelid ptosis are conditions that can affect not only appearance but your confidence. By understanding the differences between these two types of ptosis, their causes, symptoms, and treatment options, patients can make informed decisions about their health. 

At Polaris Plastic Surgery, we are committed to helping patients achieve the results they deserve. If you suspect that you or your child may have eyelid ptosis, schedule a consultation with us today.