'People keep asking me if I am eyelids droop especially toward the end of the day and I sometimes feel that I have to lift my eyelid to see!'

The above is a typical concern expressed by patients coming to see me with ptosis. The word ptosis comes from the Greek meaning 'to fall,' in medical terminology it refers to a 'droopy eyelid.' There are many causes for ptosis but a gradual onset is typically associated with the progression of time. In some patients it may occur earlier, for example, if they are contact lens wearers. Other patients may be born with 'low lying' eyelids.

Patients often explain that in the mornings they are able to 'open their eyes wide' but toward late afternoon/early evening they feel that 'their eyes are half shut.' Slippage of the levator palpebrae superioris muscle (the muscle that lifts the eyelid) from its normal attachment to the tarsal plate (the cartilage of the eyelid) is a common cause for ptosis (aponeurotic ptosis). Typically the underlying function of the levator muscle is normal but its effective 'point of pull' is too high and although the excursion of the eyelid may be normal the starting point is too low. Some patients may notice some degree of brow ache because the frontalis muscle (brow muscle) works hard to compensate for the ineffective levator palpebrae superioris.

When you attend for consultation with me it would be helpful if you could bring old photographs of yourself - a chronologic sequence of photographs of your face will help with my assessment. A list of all your prescribed and homeopathic medications would also be helpful. Please be aware that many homeopathic medications can affect clotting (eg. gingko biloba and garlic) and should, therefore, be stopped prior to surgery. After completing a careful history I will examine your eyes and eyelids closely. I initially trained as an ophthalmologist (general eye surgeon) before undertaking higher specialist training in oculoplastics. Oculoplastics deals with the function of the eyelids and associated structures that protect the eye- it is therefore imperative to have a good understanding of a patient's ocular function. Once I have completed my examination I will explain my findings to you- please feel free to ask questions and highlight any concerns.

In most instances, a surgical intervention to lift the eyelid will be required. There are, however, a number of other causes of ptosis (neurologic i.e. nerve weakness and muscular) that I must exclude Myasthenia gravis is a condition that affects the signalling process from the nerve fibre to muscle. It is, fortunately, a fairly rare condition, but its treatment is usually systemic.

For information on surgery please the section on 'Procedures'.

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