Ptosis or 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 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 with age. Congenital ptosis is present at birth and is usually due to the lack of development of eyelid muscles called levators.

Droopy eyelids interfere with vision and can lead to headaches from straining to elevate the eyelids. With congenital pstosis it is very important that the disorder is treated as soon as possible, before it begins to interfere with the affected eye’s vision or visual development. While ptosis can affect people of all ages, acquired ptosis is more common in the aging population due to the natural loss of eyelid elasticity.

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. In order to tell if you may have ptosis m any 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, known as congenital ptosis. Most cases of acquired ptosis develop as we age and our eyelid 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 or eyelid 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.They include:

  • Aging
  • Family history of ptosis
  • Birth injury
  • Eye surgery such as cataract removal
  • 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

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. 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 the levator muscles, lifting the eyelids and improving 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.

Bruising and swelling will typically last two to three weeks. If sutures are used, they will be removed shortly after. 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 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 (increased redness, swelling, pain, headache, muscle aches, dizziness, fever, nausea, or vomiting)

It is important to know that ptosis does not correct itself over time. In fact, a ptosis will continue to gradually get worse. The only way to fix a severe case of ptosis is with surgery. Choose an ophthalmologist who specializes in plastic and reconstructive surgery, and ask to see before-and-after photos of your surgeon’s previous procedures. Many people with a ptosis pursue corrective surgery for cosmetic reasons. It is important to choose a surgeon who is specialized and experienced with eyelid reconstruction.

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. If the condition is not corrected, there may be a decrease in the child’s visual development, and he or she may suffer from poor vision and possibly 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?
  • 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?
  • Are there eye exercises that can strengthen the muscles in my eyelids?

  • 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 11/2014