Ptosis Can Affect People of All Ages, Not Just the Elderly

• Ptosis (drooping eyelid) Ptosis can occur in people of any gender and age, with varying severity. It may affect one or both eyes. Although it causes no pain, it can affect vision.
• Ptosis differs from dermatochalasis (eyelid laxity), and they require different treatments. Dermatochalasis does not harm the body but may make the face look tired and older. In contrast, ptosis can interfere with vision and daily activities.
• Ptosis caused by abnormal muscle function can often be improved with surgery.

Ptosis (drooping eyelid) can affect individuals of any gender and age, with varying severity. It may be unilateral or bilateral, does not cause pain but affects vision. If abnormalities are noticed, it is advisable to see a doctor for examination and treatment planning.

How to recognize symptoms that indicate ptosis?

• A heavy sensation onthe eyelid 
• Difficulty fully opening the eyes, droopy eyelids, and possibly reduced visual field.

What causes ptosis?

• Congenital ptosis is usually present from birth or early childhood, with unclear causes.
• Age-related ptosis results from weakening of the eyelid muscles over time.
• Other causes include trauma causing eyelid lacerations, tumors around the eyelid, or abnormal muscle function.

Ptosis and dermatochalasis are different conditions and require different treatments.

• Dermatochalasis (eyelid laxity)

Dermatochalasis is the sagging or drooping of the eyelid skin, which can make the eyelid fold appear smaller in those with double eyelids or droop to the level of eyelashes in those with single eyelids. This condition does not harm health but may cause the face to look tired or older, commonly seen from middle age to the elderly.

• Ptosis (drooping eyelid)

Ptosis is characterized by the eyelid drooping over the upper edge of the pupil more than usual (normally, the eyelid margin is 1–2 millimeters below the upper edge of the pupil). It can make the face appear sleepy or sad, similar to dermatochalasis. Severe cases can interfere with vision and daily life.

Treatment methods for ptosis

• Medication: Some ptosis caused by muscle disorders, such as Myasthenia Gravis, can be treated with drugs that enhance neurotransmitter function.
• Surgical treatment

Ptosis surgery

In most cases, except those caused by abnormal muscle function, surgery can improve ptosis. After surgery, patients usually recover at home without hospital stay. Recovery takes about 7 days, and stitches are removed during follow-up. If dermatochalasis is present, it can be corrected simultaneously.

Contraindications for ptosis surgery

1.    Unfavorable health conditions ( Uncontrolled Medical Conditions )

• Uncontrolled chronic diseases such as poorly controlled diabetes, uncontrolled hypertension, severe cardiovascular disease, or untreated hyperthyroidism increase the risk of complications during and after surgery.
• Bleeding disorders: Patients with bleeding tendencies or on blood thinners (e.g., Warfarin, Aspirin, Clopidogrel) have higher risks of excessive bleeding during or after surgery. Consultation with the managing physician is recommended.
• Immunodeficiency or autoimmune diseases: Patients with compromised immunity or on immunosuppressants have higher risks of infection and delayed wound healing.
• Pregnancy and breastfeeding

2. Acute infection around the eye or systemic infection (Acute Infection) If there is an eye infection such as conjunctivitis or stye, or systemic infections like cold or fever, surgery will be postponed until recovery to reduce the risk of infection at the surgical site.

3. Severe dry eye syndrome (Severe Dry Eye Syndrome ) Surgical correction, especially over-elevation of the eyelid, may worsen dry eye due to incomplete eyelid closure or reduced tear film. Patients with severe dry eye may be considered for alternative treatments.

4. Severe corneal or retinal abnormalities If severe vision problems already exist, ptosis surgery may not fully restore vision.

5. Smoking While not an absolute contraindication, smoking increases the risk of complications such as delayed healing and infection. Doctors usually advise quitting smoking before and after surgery.

Postoperative care after ptosis correction surgery

Proper self-care after surgery is critical for treatment success, recovery, and reducing complications. Avoidances after ptosis surgery include: Ptosis (drooping eyelid) include:

• Avoid rubbing or touching the surgical wound unnecessarily, which may cause wound reopening, infection, or other complications.
• Avoid heavy exertion or activities increasing blood pressure such as lifting heavy objects, intense exercise, prolonged head-down position, straining during bowel movements, or forceful coughing or sneezing (try to sneeze or cough gently) for at least 2–4 weeks or as directed by the doctor, to reduce bleeding or swelling risks.
• Avoid washing the face directly or getting water into the eye during the first week after surgery or until the wound is dry and the doctor permits. Use gentle face wiping instead.
• Refrain from applying eye makeup for at least 1–2 weeks to prevent infection and irritation.
• Avoid smoking and alcohol both before and after surgery as advised by the doctor, to promote wound healing and reduce infection or bleeding risks.
• Avoid wearing contact lenses for at least 2–4 weeks or until permitted by the doctor to prevent irritation and infection.

Symptoms requiring immediate medical attention

• Increasing severe pain unrelieved by painkillers.
• Excessive bleeding from the wound.
• High fever.
• Red eye, eye pain, blurred vision, or purulent discharge.
• Wound swelling, redness, warmth, or abnormal pus discharge.
• Inability to close the eyelid completely or severe dry eye symptoms.

Strictly following medical advice and monitoring for abnormal symptoms helps ensure smooth recovery and the best outcomes after ptosis surgery.

Prevention of ptosis

Mostly, ptosis cannot be prevented, but self-monitoring or regular eye check-ups can help detect and treat ptosis early.

Information provided by Dr. Umyos Rattanamahattana, Plastic Surgeon,Samitivej Sukhumvit Hospital