Ptosis (Drooping Eyelid) Repair
on Long Island

Ptosis (pronounced “TOE-sis”) is a drooping of the upper eyelid. It can affect one or both eyes and ranges from a subtle asymmetry to a lid that covers part of the pupil and blocks vision. At Belaray Dermatology, ptosis is evaluated and repaired by Dr. Rachel Ellis, a board-certified ophthalmologist and fellowship-trained oculoplastic and reconstructive surgeon in Hicksville, Long Island.

What Causes Ptosis?

• Aponeurotic (age-related): The most common type. The tendon of the levator muscle that lifts the eyelid stretches or detaches over time, with contact-lens wear, or after eye surgery.
• Congenital: Present from birth, due to incomplete development of the lifting muscle. In children it can interfere with visual development and needs timely evaluation.
• Neurologic or muscular: Nerve or muscle conditions (such as third-nerve palsy, Horner syndrome, or myasthenia gravis) can cause ptosis and may require additional work-up.
• Mechanical: A mass, scarring, or swelling weighing the lid down.

Functional vs. Cosmetic Ptosis

Ptosis is considered functional when the drooping lid blocks the upper field of vision — patients often raise their brows or tilt their head back to see. It is considered cosmetic when it affects appearance or symmetry without impairing vision. Functional ptosis, documented with a visual field test, may be covered by insurance.

How Ptosis Is Evaluated

Evaluation includes measuring the eyelid position (including the margin-to-reflex distance), testing the strength of the levator muscle, checking for excess skin, and assessing eye movement, pupils, and the eye surface. When a neurologic or muscular cause is suspected, additional testing or referral is arranged. A visual field test documents functional obstruction when relevant.

Surgical Repair Options

The approach is chosen based on the cause and the strength of the lifting muscle:

• Levator advancement: The most common repair — the stretched lifting tendon is tightened through an incision hidden in the eyelid crease.
• Müller muscle–conjunctival resection: An internal approach (no external incision) for mild ptosis with good muscle function.
• Frontalis sling: For severe ptosis with very weak muscle function, the lid is connected to the brow so the forehead helps lift it.

Most adult ptosis repair is performed in the office under local anesthesia. Excess eyelid skin can be addressed at the same time when both are present.

Recovery

• Days 1–3: Swelling and bruising peak; cold compresses and head elevation help.
• Week 1: Sutures are typically removed around 5–7 days.
• Weeks 2–6: Swelling continues to settle and lid height refines. Final symmetry is assessed over several weeks.

Frequently Asked Questions

What causes a drooping upper eyelid?

The most common cause is age-related stretching or detachment of the tendon of the muscle that lifts the eyelid (aponeurotic ptosis). Other causes include congenital weakness of the muscle, neurologic or muscular conditions, and a mass or swelling weighing the lid down. A careful exam identifies the cause, which guides treatment.

Is ptosis surgery covered by insurance?

Ptosis repair may be covered when the drooping lid blocks the upper field of vision, documented with a visual field test. Purely cosmetic ptosis correction is not covered. Dr. Ellis performs the evaluation and assists with prior authorization when the condition is functional.

What is the difference between ptosis and excess eyelid skin?

Ptosis is a low eyelid margin caused by a weak or stretched lifting muscle, while dermatochalasis is excess, hooding skin. They often occur together but are corrected differently — ptosis by tightening the lifting mechanism and excess skin by blepharoplasty. Distinguishing them matters for both the result and insurance coverage.

How long is recovery after ptosis repair?

Most swelling and bruising resolve within one to two weeks, with sutures usually removed around 5 to 7 days. The final eyelid height and symmetry continue to refine over several weeks. Most adult repairs are done in the office under local anesthesia.