I have always had a drooping in my left eyelid and was even present in pictures from when
I was a child.
However, up until now, it never really gave me trouble other than cosmetic.
Now at 24 years old, I feel it may be worsening.
Recently, I have been having headaches (on that side) and discomfort and more of an overall
puffy feeling on that eyelid.
Also, the conditions seem to degrade with fatigue.
Basically, I'd like to know if I should see a doctor.
Can it be corrected with surgery?
Thank you for your question!
Based on your question, you've described that your eyelid has been droopy since you were
a child.
And that recently, at the age of 24, your eyelid has been drooping further and you've
been developing symptoms such as headaches on that side and you're asking if you should
see a doctor.
When you have symptoms that are constant, in a way it appears based on your question,
the answer is yes, you should see a doctor.
What I'm going to share with you is some of my experiences of congenital ptosis and help
you understand what options you have in moving forward.
So, assuming that you are born with this drooping eyelid, majority of the people have this history
have something called congenital ptosis.
Ptosis mean there is drooping so it's congenital eyelid ptosis.
Now what that means is that the muscle that lifts your eyelid did not develop the same
way as the normal eyelid or the eyelid that has no droop.
It means that muscle doesn't contract nor does it fully relax.
When we deal with congenital ptosis, if the child has no significant ptosis where it is
affecting visual information before the age of 6, then correction can be done at a later
time when it's more of an aesthetic issue or functional issue.
Now, one of the things that happen during congenital ptosis is that it can get worse
as people get older as the facial structure changes.
And one of the things that we also observe is that a lot of times the compensation that
people do when people have a drooping eyelid is to raise their eyebrow.
And very often, especially when the skin is more tight, you're able to effectively raise
the eyebrow and lift the eyelid.
As you get older, there's a little bit more stretch and that compensatory action can doesn't
work as well.
It's very common for people who have a long history of ptosis to say it's worse at the
end of the day.
One thing also to be aware of, in my experience, is that people with ptosis are particularly
bothered if that eye that is being affected is the dominant eye.
There is typically in every one an eye that is the preferred eye where the brain wants
to see out of that eye.
And it's referred as ocular dominance or the dominant eye.
So, it is possible, that the source of your headaches is related to the activity of the
muscle called the frontalis muscle that raises your eyebrow having tension and spasm.
Again, my recommendation is that you see an ophthalmologist as well as any other doctor
if the ophthalmologist can't give you any explanation related to your headaches and
your symptoms.
Now, assuming that everything is clear and that you're ready to have a procedure, then
eyelid surgery for congenital ptosis is typically, except for the type of ptosis that is severe
with poor muscle function, is typically some type of surgery on the levator muscle.
The levator muscle is like the word elevator but without the letter "e" that lifts your
eyelid.
And generally, when I deal with adult patients with congenital ptosis, I do something called
levator advancement.
This way, I can move the muscle forward but not sacrifice any of the muscle but can be
avoided in terms of a resection.
So that type of procedure is done so that the eyelid is more in the appropriate level
but in a more social interaction.
Remember, that muscle doesn't contract or relax like a normal eyelid muscle or a normal
levator muscle.
So it will be variable in terms when you look down or when you look up.
So 9 out of 10 times, people are very happy when their eye looks good, when they're looking
straight ahead.
It looks good for pictures, it doesn't draw attention in a social situations and it works
out pretty well.
But it's important to understand, there is a possibility that the eyelid in that type
of surgery can be too open, too low or not exactly having the right contour.
So in my practice, I always tell my patients that 95% of the time that it works out great.
After one surgery, 5% of time, you may need enhancement and that being said, you many
need an enhancer.
So you need to understand going into that decision.
So again, you may benefit from a cosmetic or levator enhancement procedure to lift the
eyelid if it does affect your vision.
But please visit a doctor about investigating these symptoms that you have and once that
is cleared up, do some research and find that right oculofacial surgeon to help you with
your drooping eyelid.
I hope that was helpful and thank you for your question.