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Last updated: Dec 05, 2022
5 min read

Droopy eyelids (ptosis): causes, symptoms, and treatment

chimene richa

Medically Reviewed by Chimene Richa, MD

Written by Mariah Adcox

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

A drooping eyelid is also known as ptosis. With this condition, the upper eyelid falls into a position that is lower than normal, sometimes even interfering with a person’s vision. In some cases, ptosis is a condition that changes a person’s appearance without affecting vision or health, but may still be distressing. In other cases, ptosis can be a warning sign of a more serious condition. If you experience ptosis that suddenly develops over a period of days or even hours, this more likely signifies a serious medical problem (McInnes, 2015). 

To learn more about ptosis, what causes it, and—most importantly—how to treat it, keep reading.  

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What is ptosis? 

“Ptosis” means drooping, and describes eyelid drooping. When the upper eyelid droops, it’s called blepharoptosis, or upper eyelid ptosis. When it affects one eye, it’s called unilateral ptosis, while bilateral ptosis affects both eyes. 

Eyelid ptosis can come and go, or it can be permanent. Congenital ptosis is when someone is born with this condition, while acquired ptosis develops later on in life. Depending on the severity of your ptosis and how much the drooping eyelid obstructs the pupil, the condition can limit your vision. This condition may resolve on its own but often benefits from medical intervention (Shahzad, 2022). 

What causes droopy eyelids?

People get ptosis for several reasons. Some people are born with one or both eyelids drooping, but ptosis can also occur later in life (aka “acquired ptosis”). In most cases of acquired ptosis, it’s just a natural part of getting older. As you age, the muscles of the upper eyelid stretch and weaken (Shahzad, 2022). 

There are cases where an illness or injury can weaken the muscles that normally raise the eyelid, resulting in ptosis. Myasthenia Gravis, for example, is an autoimmune disease that results in the muscles getting weak and tired throughout the day, and one of its main symptoms is ptosis (Beloor, 2022). Drooping can also result from nerve damage to the area which controls the eyelid muscles, like from a stroke or trauma (Shahzad, 2022). 

If you’ve recently had eye surgery, the instruments used to keep the eye open during surgery can also stretch the eyelid and cause ptosis (Park, 2017). 

Other causes of ptosis 

There are many other potential causes of acquired ptosis, including, but not limited to: 

  • Eyelid tumors, cysts, or swelling
  • Horner’s syndrome
  • Muscular problems
  • Nerve damage in the eye muscles
  • Neurological conditions
  • Eye trauma
  • Botox injections

Symptoms of drooping eyelids

The main symptom of ptosis is that one or both of the upper eyelids droop. While most people barely notice this sagging or find it happens infrequently, in some cases, ptosis can affect your vision by covering part or all of the pupil. You may also experience tiredness or an aching feeling around the eyes and may look more weary or tired than is normal for you. 

Some adults and children with ptosis tilt their heads back either at all times or when speaking, as this allows them to see normally if the eyelid is covering the pupil. 

If you experience ptosis, it’s important to visit your doctor or ophthalmologist to rule out any underlying conditions, especially if you experience sudden onset ptosis or double vision alongside the drooping eyelid.

Risk factors for ptosis

The biggest risk factor for ptosis is age, as the most common cause of ptosis is age-related. 

Eyelid trauma or eye surgeries, stitch as LASIK or cataract surgery, can also be a risk factor for ptosis. 

Sometimes eyelid lesions like styes—red, painful lumps near the edge of the eyelid that may look like a boil or pimple—can lead to ptosis simply by weighing the eyelid down. 

In rare cases, ptosis is a symptom of a more serious condition, such as a stroke, a brain tumor, or cancer of the eye nerves or muscles. Certain neurological disorders also increase the likelihood of developing ptosis, especially if these conditions usually affect the nerves of the muscles or the eyes (Shahzad, 2022). 

How to fix droopy eyelids

The treatment for ptosis depends on the severity of the condition. If your ptosis does not affect your vision and you don’t mind the appearance, you might not need treatment at all. However, if the ptosis causes problems with cosmetics, vision, or both, there are treatments available. The type of treatment you receive will then depend on what’s causing your ptosis—whether that’s aging or an underlying disease—and the severity of the ptosis. 

Ptosis caused by aging can be treated with surgery, which is typically performed under local anesthesia. Your surgeon will make an incision in the skin of the upper eyelid and find the muscles that raise the eyelids. Stitches are used to tighten the muscles, or sometimes part of the muscle will be removed, and then close the incision with more stitches. Alternatively, your surgeon can perform the entire surgery from underneath the eyelid, by flipping the eyelid and tightening the muscle from underneath. This approach requires no skin incision (Mokhtarzadeh, 2016). 

For those not interested in surgery, Upneeq is an effective prescription eye drop that can improve upper eyelid ptosis. It won’t provide the same lift you would get from surgery (and its effects last about 6–8 hours), but patients have seen about an average of 1 mm of lift in their upper eyelid after the first use. In clinical studies, Upneeq was shown to be effective for at least 6–8 hours after one daily drop (Lee, 2021). 

If you or a loved one have or are experiencing droopy eyelids, you may find some comfort in knowing that ptosis is not uncommon. You’ll first want to make sure to visit your medical provider to ensure your drooping eyelid isn’t being caused by any sort of underlying condition. Thankfully, there are treatments available for ptosis. If your condition is bothering you, talk to your healthcare provider today.  

References

  1. An, S. H., Jin, S. W., Kwon, Y. H., et al. (2016). Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis. International Journal of Ophthalmology, 9(9), 1320–1324. doi:10.18240/ijo.2016.09.15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028669/ 
  2. Beloor Suresh, A. & Asuncion, R. M. D.  (2022). Myasthenia gravis. StatPearls. Retrieved on Dec. 5, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK559331/
  3. Finsterer, J. (2003). Ptosis: causes, presentation, and management. Aesthetic Plastic Surgery, 27(3), 193–204. doi:10.1007/s00266-003-0127-5. Retrieved from https://link.springer.com/article/10.1007/s00266-003-0127-5 
  4. Griepentrog, G. J., Diehl, N., & Mohney, B. G. (2013). Amblyopia in childhood eyelid ptosis. American Journal of Ophthalmology, 155(6), 1125–1128.e1. doi:10.1016/j.ajo.2012.12.015. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905803/ 
  5. King, M. (2016). Management of ptosis. The Journal of Clinical and Aesthetic Dermatology, 9(12), E1–E4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300727/ 
  6. Lee, T. Y., Shin, Y. H., & Lee, J. G. (2020). Strategies of upper blepharoplasty in aging patients with involutional ptosis. Archives of Plastic Surgery, 47(4), 290–296. doi:10.5999/aps.2020.01361. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398815/  
  7. Lee, W. (2021). The effect of Upneeq (oxymetazoline hydrochloride 0.1%) on eyelid position, eye redness, and eye appearance. ClinicalTrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT04831047 
  8. Marenco, M., Macchi, I., Macchi, I., et al. (2017). Clinical presentation and management of congenital ptosis. Clinical Ophthalmology, 11, 453–463. doi:10.2147/OPTH.S111118. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338973/ 
  9. McInnes, C. W. & Lee-Wing, M. (2015). Eyelid ptosis. CMAJ : Canadian Medical Association Journal = Journal de L’Association Medicale Canadienne, 187(14), 1074. doi:10.1503/cmaj.140579. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4592301/ 
  10. Mokhtarzadeh, A. & Bradley, E. A. (2016). Safety and long-term outcomes of congenital ptosis surgery: A population-based study. Journal of Pediatric Ophthalmology and Strabismus, 53(4), 212–217. doi:10.3928/01913913-20160511-02. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369359/ 
  11. Park, A. J., Eliassi-Rad, B., & Desai, M. A. (2017). Ptosis after glaucoma surgery. Clinical Ophthalmology, 11, 1483–1489. doi:10.2147/OPTH.S134562. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5565377/ 
  12. Shahzad, B. & Siccardi, M. A. (2022). Ptosis. StatPearls. Retrieved on Dec. 5, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK546705/
  13. Toyka, K. V. (2006). Ptosis in myasthenia gravis: Extended fatigue and recovery bedside test. Neurology, 67(8), 1524–1524. doi:10.1212/01.wnl.0000240069.24338.c8. Retrieved from https://n.neurology.org/content/67/8/1524 

Dr. Chimene Richa is a board-certified Ophthalmologist and Senior Medical Writer/Reviewer at Ro.