What is age-related ptosis? Usually when we look straight ahead with both eyes, the upper lid margin should be at or slightly below the cornea, the upper edge of the black eye, and anything below this level is called ptosis. There are many types of ptosis, including congenital, traumatic, neurological, etc. Geriatric ptosis is usually a condition in which the upper eyelid droops to varying degrees as the older person ages, usually in both eyes, with one eye light and one eye heavy, or possibly in one eye. Why does age-related ptosis occur? Age-related ptosis is most often caused by laxity and weakness of the skin muscles and weakness of the levator aponeurosis in older adults. What are the main clinical signs of age-related ptosis? The main clinical manifestation of age-related ptosis is naturally the drooping of the upper eyelids, which makes the eyes smaller and, in severe cases, obscures the pupil and affects vision. In general, age-related ptosis is mild to moderate, meaning that the upper eyelid margin does not droop beyond the pupil; there is also some function of the levator muscle, which is manifested by some mobility of the upper eyelid. What should I do if I have ptosis in an older adult? When ptosis occurs in an older adult, the first thing to do is not to get nervous and go to the ophthalmologist to check what is causing the ptosis. First, we need to ask the patient, “Did this happen over a short period of time, or did it happen slowly, over many years? If it was a short period of time, we need to see if there were any triggers for the onset. In addition to traumatic factors, such as transient ptosis after cataract surgery, or ptosis after facial nerve palsy, which is often referred to as facial palsy, etc., there are no other triggers for ptosis. After eliminating all the triggers, ptosis is usually considered to be an age-related ptosis if it occurs slowly and becomes more severe as the patient ages. Why is it necessary to exclude all triggers? Is there a relationship with treatment? Yes, there are different treatments for different causes of ptosis. For ptosis caused by traumatic stimuli such as surgery, it is usually only transient and we will treat the cause with some treatment to restore neuromuscular function so that the ptosis gradually subsides, only a very small number of patients who do not recover in the long term will require surgery, usually six months to a year. If the ptosis occurs after facial palsy or some neurological syndrome has occurred, you will need to go to a neurologist to treat the primary cause of the ptosis. Surgery is required only when the primary condition is effectively treated and the symptoms are stabilized with varying degrees of ptosis. What are the results of surgery for age-related ptosis? The results are usually very good and can be achieved in cases of simple ptosis with no underlying cause. However, if the ptosis is due to another condition, the degree of ptosis correction should be considered appropriate to the patient’s neuromuscular function. If the ptosis is purely age-related, won’t the surgery still achieve cosmetic results? Yes, usually when we operate, we have to perform the upper eyebag removal at the same time. Also, when it comes to the removal of upper eyebags, one point needs to be made, and please note that it is important to distinguish between true ptosis or lax eyelid skin that causes prolapsed skin to shrink the lid fissure and obscure the pupil, and they are treated very differently.