KUALA LUMPUR, July 14 — With beauty and cosmetic procedures becoming more widely accepted, many individuals today are paying closer attention to how their eyes frame their overall appearance, from symmetry and eye shape to a more refreshed, lifted look. However, not every concern around the eyes is purely cosmetic.

What may be mistaken for tired-looking eyes, uneven eyelids or a reason for cosmetic eyelid surgery could, in some cases, a droopy eyelid or ptosis may signal an underlying condition, according to Consultant Ophthalmologist and Oculoplastic Surgeon at Sunway Medical Centre Velocity (SMCV), Dr Nazila Ahmad Azli.

Dr Nazila said ptosis is a relatively common eyelid condition in clinical practice, accounting for approximately eight to 12 per cent of her eyelid cases.

While it may first appear as an aesthetic concern, she said that proper assessment is important as droopy eyelids can involve the eyelid’s muscle function, nerve function or other underlying medical conditions.

The National Eye Survey III findings indicate that around 13.5 per cent of adults, particularly those over 60, may experience ptosis.

Dr Nazila said the upper eyelid functions through a coordinated lifting and closing mechanism involving the levator palpebrae superioris muscle, which lifts the eyelid, and the orbicularis oculi muscle, which closes it, with both muscles controlled by specific cranial nerves (nerves that transmit signals from the brain).

“In simple terms, ptosis means drooping of the upper eyelid. The upper eyelid works through muscles that control the opening and closing of the eyelid, and ptosis occurs when either the muscle or the nerve that innervates it malfunctions,” she said in a statement.

Depending on the underlying cause, Dr Nazila said ptosis can affect one or both upper eyelids and can either be present from birth or develop later in life.

She said congenital ptosis is usually linked to incomplete development of the eyelid-lifting muscle, while acquired ptosis is associated with age-related weakening, injury, previous eye surgery, prolonged contact lens use, frequent eye rubbing or certain medical conditions that affect nerve or muscle function.

Dr Nazila said ptosis can also be mistaken for naturally hooded eyelids, excess eyelid skin or general eye tiredness.

She said that while ptosis involves a lowered upper eyelid margin, naturally hooded eyes, medically known as dermatochalasia, involve excess skin or fat folding over the eyelid margin, while the eyelid itself remains in its normal position, creating the appearance of a drooping eyelid margin known as pseudoptosis.

As ptosis can resemble naturally hooded eyelids or excess eyelid skin, it is also one of the reasons why eyelid concerns should not be viewed only through an aesthetic lens. Dr Nazila said ptosis correction and cosmetic eyelid surgery address different concerns despite both involving the eye area and improving appearance.

She said blepharoplasty, commonly known as eyelid surgery, focuses on removing or repositioning excess eyelid skin, fat or tissue to enhance appearance, while ptosis correction restores the height and lifting function of the upper eyelid by addressing the muscle or supporting structures involved.

“People may confuse ptosis surgery with cosmetic eyelid surgery because, on the surface, both procedures improve a person’s appearance, but they correct different structures of the eyelid,” she said.

Dr Nazila said in some instances, ptosis correction and cosmetic eyelid surgery may complement each other and may need to be performed simultaneously to achieve an optimal outcome.

She said proper assessment before any eyelid procedure is important, even when the initial concern is appearance-related, as surgery performed without identifying the cause of ptosis may lead to recurrence or an unsuccessful outcome.

Dr Nazila said the priority is to determine whether ptosis is caused by a more serious medical condition, so patients receive appropriate and safe treatment.

She said assessment typically begins with a detailed medical history and clinical examination to determine the cause, severity and appropriate treatment, including eyelid measurements, levator muscle function assessment, pupillary examination, eye movement assessment and visual field analysis, where it is necessary to understand how much the drooping affects vision and daily function.

Dr Nazila said identifying the cause is especially important as ptosis can develop gradually or, in some cases, appear suddenly. While gradual changes may be linked to age-related weakening, contact lens use, previous eye surgery or other contributing factors, sudden-onset ptosis should be treated as a medical warning sign rather than a routine eyelid concern.

She cautioned that sudden-onset ptosis requires urgent medical attention as it may indicate a brain aneurysm (a weakened or bulging spot in a blood vessel in the brain), stroke or carotid artery dissection (a tear in the wall of one of the main arteries in the neck that supplies blood to the brain).

“Treatment then depends on the cause and severity of the condition. For instance, mild cases may only require monitoring, while more significant cases of ptosis may require corrective surgery to restore eyelid height, improve visual function and support a more balanced appearance,” she said.

Dr Nazila explains that ptosis surgery aims to restore function while also improving appearance, but the treatment plan must be individualised as the severity and underlying cause can vary widely from one patient to another.

Patients can also support their eye health by avoiding frequent eye rubbing, practising proper contact lens hygiene, taking regular screen breaks, managing dry eyes early and using preservative-free eye drops where appropriate.

Dr Nazila also advises the public not to take ptosis lightly and those experiencing discomfort, vision or daily function problems to seek medical attention promptly. — Bernama