Ptosis or Droopy Eyelid

Learn about the condition commonly referred to as droopy eyelids and possible treatment options to correct the problem before it begins to disturb ones visual field.

Ptosis (TOE-sis), also known as droopy eyelid or blepharoptosis, is the abnormally low position of your upper eyelid. Sometimes referred to as a “lazy eye” (amblyopia), it can affect one or both eyes. Droopy eyelids can be hardly noticeable or they can completely cover 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 or astigmatism.

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

Droopy eyelids interfere with vision and can lead to headaches from straining to elevate the eyelids. It is very important that the disorder is treated as soon as possible, before it begins to interfere with one’s vision. This is especially important in children, whose vision is still developing. Ptosis can affect people of all ages, and is not more common in one age group than another.

Symptoms of a Droopy Eyelid

The most obvious symptom of ptosis is the drooping eyelid itself. Other symptoms include difficulty shutting or opening the eye, extra skin on or around the eyelid, or the need to tilt your head back in order to see better. Eye fatigue, misaligned eyes, or double vision can also accompany ptosis. Many experts recommend that you compare a photo of yourself from ten years ago to a recent one to see if there is a difference in your eyelids. If there is, you may have developed ptosis.

Causes of a Droopy Eyelid

The causes of droopy eyelid are diverse. One can be born with hereditary droopy eyelids, also known as congenital ptosis. In some cases ptosis develops as we age and our muscles deteriorate. Droopy eyelids can also be caused by trauma or damage to the muscles that raise the eyelids or the nerves that control these muscles. Besides aging, the most common cause of droopy eyelids is the improper development of the levator muscle. The levator muscle is the muscle responsible for elevating the upper eyelid. Sometimes, ptosis can be the result of eye surgery. Eye tumors, neurological disorders, or systemic diseases like diabetes are also possible causes. Certain drugs called opioids (morphine, oxycodone, or hydrocodone) can cause ptosis. Lyrica (pregabalin) has also been known to cause mild cases of 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 involutional effect, or when the muscular connections in the eyelid weaken
  • 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 or passing it on to your children. They include:

  • Aging
  • Family history of condition
  • Birth injury
  • Eye surgery such as cataract
  • Paralysis of nerve fibers in eyelids
  • Diabetes
  • Stroke
  • Horner’s syndrome
  • Head or eyelid trauma
  • Tumor in the upper lobe of a lung
  • Brain tumor
  • Muscular dystrophy
  • Myasthenia gravis

Diagnosing Ptosis

Often your eye doctor will be able to diagnose you with an exam 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 towards the underlying cause. In some mild cases, eye exercises may strengthen weak muscles and correct the problem. Other times, special glasses may be used. 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. This may be done with a surgical procedure called blepharoplasty.

During the blepharoplasty procedure, the surgeon will tighten up your levator muscles, lifting your eyelids and improving your vision and appearance. If your levator muscles are too weak to withstand normal surgery, your surgeon may want to attach your eyelid under your eyebrow, allowing the forehead muscles to assume the task of lifting the eyelid. In most cases, there is no reported loss of eyelid movement after surgery. Although they may not look symmetrical, the eyelids will be higher than they were before the surgery. Typically, bruising and swelling will last two to three weeks. If sutures are used they are removed a week later. Drains may be placed in the incision and left for a day. Most people heal without complications within six weeks of surgery. The average hospital stay is no more than three days. Some people are given antibiotics to fight or prevent infection, while others only get pain relievers. After blepharoplasty surgery your doctor may recommend you:

  • Keep your head elevated and straight when resting at home
  • Avoid physical exercise, bending, heavy lifting, and sexual activity for a week or two after surgery
  • Return to work seven to ten days after surgery
  • Resume driving three to seven days after surgery, or as directed
  • Maintain a liquid or soft diet for the first few days after surgery; resume normal dietary habits after that
  • Call your doctor if pain, swelling, redness, drainage, or bleeding increases in the surgical area, or if you develop signs of an infection (headache, muscle aches, dizziness, fever, nausea, or vomiting)

It is important to know that ptosis does not fix itself over time. In fact, the opposite happens—it gradually worsens. The only way to fix a severe case of ptosis is with surgery. Choosing a surgeon or finding an eye doctor can be a tedious process, especially if friends or family cannot assist in referrals. Choose an ophthalmologist who specializes in plastic and reconstructive surgery, and ask to see before-and-after photos of your surgeon’s previous procedures. Ptosis can make you feel unattractive to begin with, and if your surgeon is not skilled at this critical procedure, your appearance can worsen, rquiring future corrective procedures.

Complications of Ptosis

If a child’s droopy eyelid is left untreated, he or she may develop amblyopia, or lazy eye. If the condition is not corrected, there may be a decrease in the child’s visual field, and he or she may suffer headaches. Complications may occur after blepharoplasty, such as excessive bleeding, blood clots, infection at the surgical site, scarring, asymmetrical facial muscles, and facial nerve damage. Occasionally, ptosis recurs after surgery due to errors such as an overtightened or undertightened muscle.

Talking to Your Eye Doctor

  • What is causing my droopy eyelid?
  • What tests will need to be performed to determine the cause?
  • Based on 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?
  • Are there eye exercises that can strengthen the muscles in my eyelids?
  • Which vitamins or supplements can improve my eye muscle function?
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 02/2013