One upper eyelid may sit lower than the other, or you may look tired in every photograph: doctors call this ptosis (blepharoptosis). It may affect only your appearance or narrow the upper part of your vision; rarely, it is the first sign of an urgent medical problem. Prof. Dr. Elif Betül Türkoğlu treats adults and children in oculoplastic surgery, which covers the eyelids, tear ducts, orbit and eye prosthesis surgery.
What causes a droopy eyelid?
The upper lid is raised mainly by the levator muscle, through a broad, thin tendon (the aponeurosis), with help from the small Müller's muscle on the lid's inner side. A problem in these muscles, the tendon or their nerves can make the lid droop.
- Age-related (aponeurotic) ptosis, the most common adult type: the tendon thins, stretches or detaches, a process that long-term contact lens wear, frequent eye rubbing and eye operations such as cataract surgery can speed up. The muscle usually keeps its strength.
- Congenital ptosis: usually an underdeveloped levator, so the lid sits low and moves less; it can affect a child's visual development.
- Nerve and muscle conditions: mainly third (oculomotor) nerve palsy, Horner syndrome (mild droop, smaller pupil on the same side) and myasthenia gravis (a droop that varies during the day and worsens with tiredness). The underlying disease is investigated first.
- Mechanical causes: a lump, scarring or marked swelling; a new or growing lid swelling must be diagnosed first, as it can be a tumor (see eyelid tumors). Forehead botulinum toxin injections can cause a temporary droop.
Excess lid skin (dermatochalasis) or low eyebrows can mimic ptosis; excess skin is corrected with blepharoplasty rather than ptosis surgery, and many people have both.
What symptoms does ptosis cause?
- One or both upper lids sitting low, often asymmetrically
- A narrower upper field of vision, noticed most when driving or late in the day
- Raising the eyebrows or tilting the head back to see, with forehead strain and headaches
- In children, a raised chin or one eye kept less open
When is a drooping eyelid an emergency?
A droop that develops over years is not an emergency; a sudden one is different.
What happens at the consultation?
Prof. Türkoğlu, who began her specialist career in 2010 in the oculoplastic unit of Sakarya University Training and Research Hospital and is a member of the American and European oculoplastic societies (ASOPRS, ESOPRS), asks when the droop began, whether it varies during the day, about previous eye surgery and about blood thinners; old photographs help to date its onset. The examination includes:
- lid height relative to the pupil and the difference between the eyes, in millimeters;
- levator function, the lid's travel from looking down to looking up, which largely decides the technique;
- brows, eye movements, pupils and tear film, to predict dryness after surgery;
- in mild ptosis, the phenylephrine test: a drop stimulating Müller's muscle shows how far the lid may rise and whether surgery from the inside of the lid suits you;
- if needed, a visual field test of how much vision the lid blocks.
She then explains whether surgery is needed, which technique suits you and what you can realistically expect.
Which operation is used for ptosis?
Surgery is the lasting treatment for age-related and congenital ptosis; the technique depends on the degree of droop and the strength of the levator:
| Technique | How it is done | Usually for |
|---|---|---|
| Levator advancement (aponeurosis repair) | Loosened tendon shortened and reattached via a lid-crease incision | Age-related ptosis with good muscle function; excess skin can be removed too |
| Müller muscle–conjunctival resection | Small strip of tissue removed from inside the lid; no skin incision | Mild to moderate droop responding well to phenylephrine |
| Levator resection | Muscle and tendon shortened | Congenital ptosis with moderate muscle function |
| Frontalis sling | Thin sling linking the lid to the forehead muscle; raising the brow lifts the lid | Very weak or absent muscle function |
Adults usually have local anesthesia, with light sedation if needed, and may be asked to open and close their eyes so that the lid height can be set during movement. Children need general anesthesia. Most patients go home the same day. Both upper lids receive equal nerve signals, so raising one can make the other drop slightly; both eyes are therefore assessed together.
Why does ptosis matter in children?
Vision develops in the first years of life. If a drooping lid covers the pupil, the brain receives no clear image from that eye and lazy eye (amblyopia) can develop; a lid pressing on the eye can also cause astigmatism and, in turn, lazy eye. Children with congenital ptosis therefore need regular vision and glasses checks. If the lid blocks the line of sight, surgery is not postponed; glasses or patching for lazy eye continue before and after surgery.
What is recovery like?
| After surgery | What usually happens |
|---|---|
| First few days | Swelling and bruising increase, then subside; cool compresses and a raised head help |
| About one week | Stitches are checked or removed; many people resume light activities |
| A few weeks | Bruising fades and the lid settles at its new height |
| A few months | The scar softens and fades; the final result can be judged |
At first the eye may not close fully during sleep, so lubricating drops and a gel at night are usually advised. Until the wounds heal, avoid rubbing the eye, eye makeup and swimming. Blood thinners are adjusted only with the agreement of the prescribing doctor.
What are the risks?
Most side effects are temporary: bruising, swelling, stinging and dryness. Less often, the lids end up asymmetric, the lid is raised too little or too much, the crease is uneven, infection develops or a corrective operation is needed. The aim is a clear, natural-looking improvement; symmetry to the millimeter is not always achievable. If you develop severe or increasing pain, a tense swelling pushing the eye forward or reduced vision, contact your surgeon or an emergency department immediately.
Traveling to Antalya for ptosis surgery
If you live outside Türkiye, you can send photographs taken from the front, eyes open and looking up, through the contact details for a preliminary assessment. After straightforward ptosis surgery, about a week in Antalya is usually enough: fly home after the stitch check. Consultations are in English or Turkish; a Russian-speaking interpreter can be arranged through BergemHealth. The international patients guide covers records, travel and accommodation.
BergemHealth
Traveling from abroad?
BergemHealth, the practice's international patient coordination partner in Antalya, can arrange airport transfers, accommodation near the clinic, interpreters (English and Russian) and appointment scheduling. All medical decisions are made by Prof. Türkoğlu.
BergemHealth is a licensed travel agency in Antalya (TÜRSAB license A-8469).
Frequently asked questions
Is ptosis surgery painful?
The local anesthetic injection stings briefly; after that the operation is usually not painful, though you may feel pressure or pulling. Afterwards, tightness and a mild ache are typical and usually respond to simple painkillers and cool compresses.
Can a droopy eyelid get better without surgery?
It depends on the cause. A droop after botulinum toxin usually wears off within a few weeks, and treating myasthenia gravis with medicines can reduce its droop. Age-related and congenital ptosis cannot be corrected permanently with exercises, massage or creams; surgery is the lasting treatment.
What is the difference between ptosis surgery and blepharoplasty?
Blepharoplasty removes excess skin and, if needed, some fat; ptosis surgery repairs the lifting muscle or its tendon. The two problems often occur together and can be treated in one operation; measuring lid height and muscle function shows which you need.
Will there be a scar?
Levator advancement uses an incision in the natural lid crease, hidden when your eyes are open. Müller muscle surgery is done from inside the lid, leaving no visible scar. A frontalis sling may need small incisions above the brow. Scars soften and fade over a few months.
Can the eyelid droop again after surgery?
In most patients the result lasts many years, but surgery does not stop aging, and the tendon can loosen again. Some patients need a small adjustment operation early on, and in children a frontalis sling may need readjusting as they grow.
My child has a droopy eyelid. Should we wait until they are older?
Not if the lid covers the pupil or if lazy eye or astigmatism is developing. If the droop is mild and vision is developing normally, surgery can be planned for a more suitable age, with regular vision checks meanwhile. Decide with an eye doctor who has examined your child's vision and lid movement.
References
- American Academy of Ophthalmology. Blepharoptosis. EyeWiki. eyewiki.org
- American Academy of Ophthalmology. Congenital Blepharoptosis (Ptosis). EyeWiki. eyewiki.org
- American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Ptosis. aapos.org