How Eyelid Ptosis is Defined by Measuring the Eyelids in Relation to the Iris and Pupil

Author: Amiya Prasad, M.D.

Thank you for your question. You are 20 years old and you state in your question that you don’t like how your eyelids look and you are asking if you have ptosis. And you describe in your question the situation where you are having difficulty keeping your eyes open when you are driving and that you have frequent headaches and you want to know what your options are. Well, I can certainly assist you with this question. I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and reconstructive surgeon.

This means that my background training first was eye surgery and then I underwent specialty training in plastic and reconstructive surgery of the eyelids. And that field, certainly ptosis is a very important area for what we do. I practice cosmetic oculofacial plastic and reconstructive surgeon in Manhattan and Long Island and I’ve been in practice for over 20 years and so I certainly treated a lot of ptosis. So with the single photo you submitted in terms of understanding the definition of ptosis, I think we can be confident in just defining the presence of ptosis with that one photo. Now ptosis basically means drooping.

Now when it is eyelid ptosis, it’s called eyelid ptosis but it can affect the breast and it can be the breast ptosis. So as far as ptosis is concerned, the normal position of the eyelid is typically 1-2 mm between the upper part of the colored part of the eye called the iris. So that there is at least 2 mm from the center of the pupil or the approximate center that we refer to as the light reflex of margin to eyelid reflex distance. So with that understood, looking at way your eyelid is positioned relative to the pupil, I think it is very safe to state that you do have ptosis. Now someone like you who is 20 years old comes in, the question that I have first is this congenital ptosis meaning that you are born with it or is this acquired ptosis? Now congenital ptosis can be present and can slightly be worst as you get older and with the acquired ptosis it’s something than often needs a little bit more examination before moving forward to surgical procedure. So it is important for you to look at photos, look at the photos from a year ago, 2 years ago, 5 years ago look to see if you always have this. A lot of times, people who are born with this ptosis have never really realized that they never had ptosis and sometimes they will be told by their family and friends that they have “bedroom eyes” which is fine.

It can also be a natural normal appearance although technically and medically speaking, it is ptosis with that. If the eyelid appearance has been stable for a long time, then it is reasonable to consider a surgical procedure to help you have the eyes look more even. If, however, this is something that is new, well it is important to see an ophthalmologist and in particular possibly a neuro-ophthalmologist to determine whether or not there may be a neurologic reason for this change. Given that this is a solitary photo, when I examine a patient with ptosis ,I have them look down, look up and I take measurements of the muscle functions and I would review photos. And sometimes, I would have patients come back more than once to see what they look like at different times. Establishing the diagnosis is critical before moving forward with surgical procedure and ptosis surgery can be very effective and it can really change the whole face and it’s a deceptively complex because it involves working with the levator muscle. And depending on the level of ptosis you have or degree of ptosis, that muscle has to be dealt with and managed very carefully.

How Eyelid Ptosis is Defined by Measuring the Eyelids in Relation to the Iris and Pupil

And in fact it, is routine for us when we do this surgery to actually sit a patient up during the procedure to adjust the position, the height, the contour, the shape and the symmetry. So it’s a very advanced eyelid procedure and it is something that requires a lot of experience and finesse to optimize the results. And even with all that, there can be a variability to the outcome. The eyelid can be too open or too low and you may require revision surgery but again that’s more if this is the path that needs to be pursued once the proper diagnosis is made.

I recommend that you meet with a medical doctor or an ophthalmologist to first address this concern. Having this proper evaluation and it may require more doctors in order to at least eliminate neurologic reason before moving forward with the ptosis surgery and then identifying a ptosis surgery specialist who you feel will be right for you. I feel that the cosmetic element of ptosis or any reconstructive surgery is so important which in my practice cosmetic oculofacial plastic and reconstructive surgery, that’s the emphasis for patients who will often say to me that they have been to other oculofacial plastic surgeons but because there are offices, they did a lot more medical and less cosmetic. They felt more comfortable finding someone like myself and now of course that is just one perspective but that is just my experience in the decisions I made many years ago in focusing on cosmetic elements in the reconstructive types of surgery I do. So this is can be a learning experience for you and you should pursue meeting with doctors moving forward but I think we can answer the question reasonably by saying yes, this does appear to be ptosis but beyond that, you need proper examination and physical evaluation to learn more about what your options are. So I hope that was helpful, I wish you the best of luck and thank you for your question!.

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