Drooping Eyelid (Ptosis): What Is It and How Is It Treated?

A drooping eyelid (ptosis) is when the upper eyelid sits lower than normal. It can affect one eye or both; it may be present from birth or develop later. When mild, it gives the face a tired expression; when marked, it can narrow the field of vision. A drooping eyelid is not always just a cosmetic problem; the underlying cause should be investigated by a doctor.

True and False Drooping Eyelid

In a true drooping eyelid, the problem lies in the muscle that lifts the eyelid (the levator muscle), in the connective tissue by which this muscle attaches to the lid, or in the nerve that controls the muscle. In a false drooping eyelid, the lid is at a normal height, but upper eyelid skin that sags with age or drooping eyebrows rest on the lid and create a drooping appearance. The two conditions are treated differently, so the distinction needs to be made at the examination.

What Causes a Drooping Eyelid?

A drooping eyelid present from birth is mostly caused by the muscle that lifts the eyelid not developing sufficiently in the womb. The most common cause of a drooping eyelid that develops later is the loosening, with age, of the connective tissue by which the muscle attaches to the lid. Long-term contact lens wear, eye surgery, injuries, nerve and muscle diseases and masses on the eyelid can also cause drooping. A temporary droop can also occur after botulinum toxin treatments around the eyes. For detailed information on the causes you can read our article What Causes a Drooping Eyelid?.

Symptoms

The following symptoms may occur with a drooping eyelid:

  • The upper eyelid sitting low in one or both eyes
  • Constantly raising the eyebrows or tilting the head back to see better
  • Forehead, neck and headaches caused by this effort
  • A tired and dull expression on the face
  • Narrowing of the field of vision, especially in its upper part

When Should You See a Doctor Immediately?

If a drooping eyelid starts suddenly and is accompanied by double vision, a difference in pupil size, a severe headache, restricted eye movements or a droop that varies during the day, a doctor should be seen urgently without waiting. These symptoms may be a sign of a serious condition affecting the nervous system or the muscles. In children, a droop that covers the pupil can lead to a lazy eye, so early assessment is important.

Treatment Methods

Treatment is planned according to the cause and degree of the droop, the strength of the muscle that lifts the eyelid and the person's age. If there is an underlying disease, it needs to be treated first; some conditions, such as a droop caused by botulinum toxin, may improve on their own over time. The permanent treatment for a true drooping eyelid is surgery:

  • If the muscle is strong enough, the lid is raised by shortening or reattaching the muscle that lifts the eyelid or its connective tissue.
  • If the muscle is very weak, the eyelid is connected to the forehead muscle with a thin sling material, so that the forehead muscle helps lift the lid.

In a false drooping eyelid, the sagging skin is removed with upper eyelid surgery (blepharoplasty); drooping eyebrows may be treated with a forehead lift at the same time. Exercises and device treatments do not correct a true drooping eyelid. For detailed information you can read our eyelid surgery page.

After Surgery and Risks

Swelling and bruising around the eyes are expected after surgery. Cold compresses are applied as recommended by the doctor, the eyes are not rubbed and the prescribed medicines are used regularly. The doctor determines when the stitches are removed and when to return to daily life.

Like any surgical procedure, drooping eyelid surgery has risks. A difference in height or crease between the two eyes, the lid being raised more or less than expected, being unable to close the eye fully and the resulting dry eye, infection and bleeding may occur; in some cases an additional corrective operation may be needed. For a droop affecting one eye you can read our article Causes of a Drooping Eyelid on One Side.

Author: Op. Dr. Yücel Sarıaltın