Ptosis (Droopy Eyelid)

Ptosis (TOE-sis), also known as droopy eyelid or blepharoptosis, is the abnormally low position of your upper eyelid. Droopy eyelids vary in severity, and can range from hardly noticeable to completely covering the pupil, iris, and other parts of the eye. If severe or left untreated, the droopy eyelid can lead to other conditions such as amblyopia (lazy eye) or astigmatism.

There are two types of ptosis: acquired and congenital. Congenital ptosis is present at birth and is usually due to the lack of development of eyelid muscles called levators. Acquired ptosis is the most common type, and is usually due to the muscles that elevate the eyelid becoming weak, thin, or stretched with age.

Droopy eyelids interfere with vision and can lead to fatigue from straining to elevate the eyelids. When congenital ptosis affects visual development in children, surgery may be required to prevent the development of amblyopia. Ptosis must also be differentiated from dermatochalasis, which is simply extra eyelid skin that can also cause the appearance of a droopy eyelid. The causes and treatment for dermatochalasis are very different than for ptosis.

Symptoms of a Droopy Eyelid

The most obvious symptom of ptosis or blepharoptosis is the drooping eyelid itself. Other symptoms include difficulty opening the eye or the need to tilt your head back in order to see better. Eye fatigue, misaligned eyes, or double vision can also accompany ptosis. You or your doctor may compare a photo of yourself from ten years ago to a recent one to see if there is a difference in your eyelids.

Causes of a Droopy Eyelid

The causes of droopy eyelid are diverse. One can be born with hereditary droopy eyelids, a condition known as congenital ptosis. Most cases of acquired ptosis develop as we age and the tendon that helps keep the eyelid open stretches and loosens. Droopy eyelids can also be caused by trauma, surgery, or by damage to the muscles that raise the eyelids or to the nerves that control these muscles. Tumors, neurological disorders, systemic diseases, and certain drugs have also been known to cause ptosis.

Depending on the cause, ptosis may be classified as:

  • Neurogenic ptosis: Refers to the condition in which the nerves attached to the muscle are affected
  • Myogenic ptosis: Refers to sagging of the lid due to a problem with the muscle that raises the eyelid
  • Aponeurotic ptosis: Refers to the stretching and weakening of the tendon responsible for raising the eyelid
  • Mechanical ptosis: Refers to a condition in which the weight of the eyelid is too great for the muscles to lift

Risk Factors for Ptosis

A variety of factors may increase your risk for developing ptosis. They include:

Diagnosing Ptosis

Your eye doctor will be able to diagnose ptosis with an examination of your affected eyelid. He or she will ask you questions about your symptoms, family medical history, and personal medical history. In some cases medical tests are conducted to determine the cause of acquired ptosis. Because there are a number of reasons why an eyelid might droop, it is highly recommended that you get a diagnosis from an eye doctor, even if symptoms are mild.

Treating a Droopy Eyelid

If symptoms of ptosis are mild, treatment may not be necessary. Specific treatment is usually directed toward the underlying cause. Special glasses may be used in some cases; these glasses have a crutch attached to hold up the eyelid. In moderate to severe cases, surgery may be the only option to correct the eyelid.

The most common surgery used to treat ptosis is a levator aponeurosis advancement. During this procedure, the surgeon will tighten up the levator tendon, lifting the eyelids. Occasionally, such as in cases of congenital ptosis, the levator is too weak to allow for eyelid opening; in this case, a “sling” is used to allow the forehead muscles to assume the task of lifting the eyelid. Although they may not look symmetrical, the eyelids will be higher than they were before the surgery.

Bruising and swelling will typically last two to three weeks. Most people heal without complications within six weeks of surgery. Typically, this is done as outpatient surgery, meaning there is no hospital stay.

It is important to know that ptosis does not correct itself over time. The only way to fix a severe case of ptosis is with surgery. Most of these procedures are performed by oculoplastic surgeons, ophthalmologists who pursue extra training in eyelid surgery.

Complications of Ptosis

If a child’s droopy eyelid is left untreated and is severe enough, he or she may develop amblyopia, or lazy eye. Complications that may occur after eyelid surgery include excessive bleeding,  infection at the surgical site, scarring, asymmetrical facial appearance, and facial nerve damage.

Talking to Your Eye Doctor

  • What is causing my droopy eyelid?
  • What tests will need to be performed to determine the cause?
  • Taking into account the severity of my case, what are my treatment options?
  • Will you be the one performing my surgery? If not, will you refer me to a specialist, or will I need to find my own?

Did you know … Actor Forest Whitaker refuses to have surgery to correct ptosis in his left eye?

References:
  • J. Anshel, MD “Smart Medicine for Your Eyes” (SquareOne Publishers, 2011) 206-208
  • J. Lavine, MD “The Eye Care Sourcebook” (Contemporary Books, 2001) 79-81
  • S. Moore, MD; S. Yoder, MD “Complete Guide to Symptoms, Illness & Surgery” (The Berkeley Publishing Group, 2006) 557; 820
This article was last updated on 03/2015