Ptosis: Why Is My Eyelid Drooping? 

Published November 2, 2020

What is ptosis?

Ptosis, commonly referred to as a droopy eyelid, occurs when the upper eyelid droops down over the eye.

A droopy eyelid can affect one eye (unilateral ptosis) or both eyes (bilateral ptosis) and be mild or severe, intermittent or permanent.

When ptosis limits your vision, reading, playing, driving, and even walking can be difficult. 

Symptoms of ptosis

The most common symptom of ptosis is drooping of one or both eyelids. 

Additionally, if your vision is obstructed, you may find that you need to tilt your head back or arch your eyebrows for improved vision.

Other common symptoms include:

If you begin to experience migraine headaches following the onset of ptosis, be sure to mention this to your doctor as it could be a sign of a more serious condition.

What causes a drooping eyelid?

While ptosis is more common among older adults, it can develop at any age.

Conditions that can cause ptosis include:

Congenital ptosis

While uncommon, this condition can occur when the levator muscle in the top eyelid has not developed properly. When a child is born with ptosis, their vision can be affected from a young age— leading to a delay in their vision development and/or a lazy eye (amblyopia).

Acquired ptosis

This occurs when an eyelid droop develops from an underlying condition, such as:

    • Myogenic ptosis: when the eyelid cannot elevate properly due to certain diseases, such as myasthenia gravis, congenital myopathies, and myotonic dystrophy
    • Aponeurotic ptosis: when the levator muscle weakens as a result of aging, making it difficult for the muscle to lift the eyelid into its proper position
    • Mechanical ptosis: when an eyelid tumor, or other growth causes the eyelid to become too heavy to lift
    • Neurogenic ptosis: when there is nerve or central nervous system damage
    • Traumatic ptosis: when the levator muscle becomes dislocated following a trauma to the eye

How is ptosis diagnosed?

If you are experiencing symptoms of a drooping eyelid, schedule an eye exam as soon as possible. 

Your eye doctor will conduct a full history to determine what may be causing the ptosis and the most appropriate treatment plan.

Your eye doctor may ask you the following questions:

  • Date of onset
  • Duration
  • Severity
  • Aggravating/alleviating factors
  • Variability

Your eye doctor may also perform a series of tests to determine the cause of the ptosis:

Slit lamp test – This diagnostic device provides high intensity light and magnification to allow your eye doctor to examine your inner eye. Your eyes may be dilated for this test.

Tensilon test – This test is used to rule out myasthenia gravis. During this test, a drug called Tensilon is injected into one of your veins. Your doctor may ask you to stand up and sit down or cross and uncross your legs as your muscle strength is examined. Improved muscle strength with Tensilon administration is generally linked to a positive test, indicating a possible diagnosis of myasthenia gravis.

Visual field testThis test is used to determine if the nerves of the retina have been affected by the ptosis.

Eyelid tests – Your eye doctor may take measurements of your eyelid’s height and strength to determine if the drooping eyelid is mild, moderate, or severe.

Can ptosis be treated?

In most cases, ptosis can be treated with medical intervention, though sometimes, especially among children, it can disappear spontaneously. 

Treatment generally depends on the underlying cause and severity of the ptosis.

Ptosis caused by an underlying medical condition is generally treated through management of the medical condition. If your eyesight is limited or obstructed, surgery may be recommended as well.

Surgery: Ptosis surgery involves tightening the levator muscle to elevate the eyelid. This surgery is generally recommended for children in order to prevent a lazy eye that can inhibit the normal development of the visual system

A “sling” operation is another type of surgery that involves moving the forehead muscles to lift the eyelids.  This surgery may be recommended if the levator muscle is extremely weak.

Though uncommon, as with any surgery there can be risks of complications, such as:

  • Dry eye
  • Corneal abrasion
  • Hematoma (collection of blood)
  • Positioning the eyelid too high or too low

Ptosis Crutch: If you are not a good candidate for surgery, a ptosis crutch may be recommended.

A ptosis crutch is a specialized device meant to hold the eyelid in place and prevent it from drooping. The device is attached to the frame of any type of eyeglasses, though metal frames work best.

For unilateral ptosis, an adjustable crutch is attached to one side of the frame. For bilateral ptosis, a reinforced crutch is attached to both sides of the frame.

Risk factors 

Certain medical conditions can increase your risk of developing ptosis:

  • Stroke
  • Diabetes
  • Stye
  • Brain tumor
  • Cancer of nerves or eye muscles
  • Myasthenia Gravis
  • Cranial nerve III palsy
  • Horner’s syndrome

In some cases, laser eye surgery (LASIK) or cataract surgery can cause ptosis if the muscle or tendon was stretched during the procedure.

Can I prevent ptosis?

Unfortunately, there is no way to prevent a drooping eyelid. However, if you notice that your eyelid is beginning to droop, schedule an appointment with your eye doctor as soon as possible.

Prompt treatment will help to prevent the ptosis from worsening.