Summary
Ptosis describes an upper eyelid that sits lower than it should, sometimes affecting how much you can see, sometimes simply giving a tired or asymmetric appearance. Most ptosis is caused by gradual stretching of the levator muscle that lifts the eyelid; some is congenital, and a small number have an underlying neurological cause that needs investigating first.
Who is this for?
I commonly see patients who notice one or both eyelids drooping over the iris, often with:
- difficulty reading or driving as the eyelid tires through the day,
- a brow ache from constantly raising the eyebrow to compensate,
- a tired or asymmetric appearance in photographs.
A small group of patients have ptosis as part of a wider condition (myasthenia, third-nerve palsy, Horner’s syndrome) and these are excluded carefully before recommending surgery.
Is this funded on the NHS?
For most of Hampshire, no. The same Policy 52 that excludes upper-lid skin surgery covers ptosis in the same sentence, so NHS Hampshire and the Isle of Wight does not normally fund it and sets no threshold you could meet; the only route is an individual funding request. The North East Hampshire locality is the exception, having kept the Frimley criteria when it joined the board in April 2026. The boards next door take a different view of the same patient: Thames Valley will consider surgery on a margin reflex distance of 2 mm or less, or superior field loss of at least twelve degrees, while Surrey and Sussex asks for a named visual field test in the relaxed, non-compensated state, and Dorset uses a different field standard again. Congenital ptosis and ptosis with a neurological cause are a separate question and are not what these policies are about. A droop that has come on suddenly needs assessing urgently, not a funding discussion. If you want to know whether the NHS funds ptosis surgery where you live, it is set out board by board, with the source for each.
I see NHS and private patients in the same unit at Queen Alexandra Hospital. If your area does not fund the operation, if you do not meet the published criteria, or if you would rather not wait, that is a private consultation. The same applies if you want the functional problem and the appearance treated together, which the NHS will not do.
What the procedure involves
Surgery is tailored to the cause. The most common operation is an anterior approach levator advancement, performed through the natural eyelid crease, under local anaesthetic with light sedation. Where the levator muscle is very weak (typically severe congenital ptosis), a frontalis sling is used instead, harnessing brow movement to lift the lid.
The operation usually takes 30 to 45 minutes per eyelid. You’re awake but comfortable, so I can ask you to open and close your eyes during surgery to fine-tune the height.
Recovery and what to expect
- The first 48 hours: bruising and swelling, helped by ice packs and head elevation.
- Week 1: sutures removed at around 7 days. Most patients are back to desk work in a week.
- Weeks 2 to 6: swelling settles, the eyelid crease softens and the final height becomes apparent. Heavy exercise can usually resume after 2 weeks.
- 3 months: the result is essentially settled.
A small amount of dryness for the first few weeks is normal; preservative-free lubricants are prescribed routinely.
Risks and alternatives
Ptosis surgery is highly successful but, like any operation, has small but real risks. These include under- or over-correction, asymmetry, eyelid contour irregularity, dry eye, infection, and (very rarely) bleeding behind the eye. Approximately 5 to 10% of patients need a small adjustment within the first few months.
For very mild or borderline cases, particularly where dermatochalasis (excess upper-lid skin) is the dominant problem, an upper blepharoplasty alone may be more appropriate.