Ptosis: Droopy Eyelid Causes and Treatment

If your upper eyelid droops down and covers part of the eye, it can be a sign of ptosis.

It’s often called a “droopy eyelid” because that’s what it looks like: one of your eyelids is lower than the other.

Ptosis, or droopy eyelids, can happen to anyone, male or female, of any ethnicity, but it’s more common as we age.

It can be mild, moderate, or severe and can happen in one or both eyes.

Some people experience ptosis at birth or develop it later in life.

Sometimes it can be caused by an injury or a medical condition, but the cause is often unknown.

Ptosis can heal on its own or with help from a doctor, depending on what caused it, how bad it is, and whether or not there are other eye or nerve problems.

Who Gets Droopy Eyelids?

Droopy eyelids can affect people of all ages, but they are more common in the elderly.

As we age, the muscle that lifts the upper eyelid can get stretched out and weaken.

As a result, it causes the eyelid to droop or sag.

Ptosis can also be present at birth, a condition called congenital ptosis, or it can happen later in life.

Other causes may include the following:

• Genetics
• Injury
• Certain medical conditions such as diabetes, thyroid disorders, or nerve disorders

If you are experiencing drooping or sagging of the upper eyelid, talk to a doctor or a qualified and experienced ophthalmologist.

They will assist you in determining the source of the problem and will advise you on the best course of action.

Ptosis in Children

Congenital ptosis is one of the most common types of ptosis in children. It usually occurs at birth.

Children can have ptosis for many different reasons.

• Malfunction or underdevelopment of the muscle that lifts the eyelid or the nerve that controls the muscle.
• Neurogenic ptosis: A condition caused by a problem with the nerve that controls the muscle that lifts the eyelid. The nerve may be affected by various conditions, such as a brain injury, a brain tumor, or a nervous system disorder.
• Myogenic ptosis: Also known as congenital or acquired ptosis, it is a type of droopy eyelid caused by muscle weakness or dysfunction with the levator muscle.
• Myasthenia gravis (MG): This chronic autoimmune neuromuscular disorder causes muscle weakness.
• Inherited disorders: Affect the levator muscle’s function or structure, which is responsible for elevating the eyelid.
• Trauma: Damages the levator muscle leading to weakness or paralysis, which can cause the eyelid to droop.
• Infection: Such as Orbital and preseptal cellulitis, herpes zoster, and Lyme disease affects the muscles and nerves that control the eyelid.

Risk Factors of Droopy Eyelid

Certain risk factors can increase your likelihood of developing a droopy eyelid.

• Age: As we get older, the muscle that lifts the eyelid can become stretched and weaker, leading to drooping or sagging of the eyelid.
• Genetics: Some people are born with a genetic predisposition to ptosis, which means they may be more likely to develop the condition.
• Medical conditions: Certain conditions can increase the risk of developing ptosis, such as diabetes, stroke, thyroid disorders, cancer, or nerve disorders.
• Injury: Trauma to the eyelid or surrounding area can increase the risk of developing ptosis.
• Medications: Some medications can cause muscle weakness or other side effects leading to ptosis.

What Are the Symptoms of a Droopy Eyelid?

The main sign of droopy eyelids is that the upper eyelid droops or sags.

Once this happens, it can cause the eyelid to cover part or all of the iris and pupil.

Other symptoms can include:

• Tired appearance: The drooping eyelid can give an impression of being tired or sleepy, even when the person is well-rested.
• Blurred vision: The drooping eyelid can cause the eyelashes to rub against the cornea, causing irritation and blurred vision.
• Increased tearing: The drooping eyelid can cause the eye to tear more than usual, as the drooping eyelid can block the drainage channels for tears.
• Head tilting: To see correctly, some persons with ptosis may need to tilt their heads back into a chin-up position.
• Eyelid lifting: Some people with ptosis may lift their eyelids with a finger to see correctly.
• Forehead and scalp muscle activation: Continuous activation of the forehead and scalp muscles may cause tension headaches and eyestrain.

How Is a Droopy Eyelid Diagnosed?

Your ophthalmologist will evaluate the eyelid position, muscle function, and the patient’s vision.

They will also ask when your symptoms began and about any medical history related to your condition.

After you answer questions about your problem, your doctor may do a series of tests to determine the cause of your drooping eyelid and rule out any underlying health issues.

Some of these tests may include:

• Visual acuity test: This test measures the patient’s ability to see clearly at different distances.
• Slit-lamp examination: This test allows the ophthalmologist to examine the eyelid, cornea, iris, lens, and retina.
• Levator function test: This test measures the strength of the muscle that lifts the eyelid.
• Cover test: This test compares the movement and alignment of the two eyes.
• CT/MRI scans: Your doctor may use imaging tests such as CT and MRI scans to evaluate the brain, orbit, and thorax for any underlying conditions.

If a neurological issue is the cause of your ptosis, your doctor may recommend that you see a neurologist.

How Is a Droopy Eyelid Treated?

Treating a droopy eyelid depends on the cause and severity of your condition.

If your condition is minor, you may not need treatment.

Your surgeon may recommend observing the progress before suggesting any treatment options.

When droopy eyelids block the visual axis, doctors may recommend using glasses or contact lenses to help improve vision.

In cases where it is a congenital ptosis, the child’s brain has been affected.

The doctor may also suggest that the child with ptosis wear an eye patch to help the brain develop the visual pathways in the eye.

Surgery

The most common treatment for ptosis is surgery.

If your ptosis is severe and getting in the way of your vision, in that case, your doctor may suggest you undergo eyelid ptosis surgery.

The type of eyelid surgery you get will depend on the cause, the severity, and the muscle function.

Some of the surgery options available include:

• For minimal ptosis, a surgeon can use either Müller’s muscle conjunctival resection or the Fasanella Servat procedure.
• Levator palpebrae shortening or levator muscle advancement for moderate ptosis with a 5-10 mm levator function.
• Brow/frontalis suspension for severe ptosis with a levator function <5 mm.

Related: Ptosis Surgery Costs: Understanding The Cost of Fixing Droopy Eyelids.

Medication

Depending on the underlying cause of your condition, the doctor may use certain medications to treat your droopy eyelids.

They include the following:

• Neuromuscular blocking agents: Drugs like apraclonidine and carbachol temporarily stop the eyelid muscle from moving, which lets you lift a drooping eyelid.
• Cholinergic agents: These medications, such as pilocarpine, increase the activity of acetylcholine, a neurotransmitter that aids in the contraction of the muscle that controls eyelid movement.
• Botulinum toxin: Also known as Botox, it’s used to weaken the muscle that causes the eyelid to droop, allowing you to lift it. It’s a temporary solution, and you should repeat it every few months.
• Prostaglandins: These medicines, such as latanoprost, work by increasing the flow of blood to the eyelid muscle, helping to strengthen it and lift the droopy eyelid.
• Topical drugs: Like apraclonidine, can temporarily improve ptosis caused by Horner’s syndrome, a sympathetic nervous system disorder. These medications work by constricting the blood vessels and reducing the swelling in the affected eye.

Ptosis Crutch

A ptosis crutch is a small device that you can use to lift a droopy eyelid and improve your vision.

It’s a small plastic or metal piece that you place on the inside of your eyeglasses, sitting on top of your eyelid.

It helps lift your droopy eyelid and keep it open, which can improve your vision and reduce the tired, heavy appearance of your eyelid.

You can use a ptosis crutch as a temporary fix while you wait for surgery or as an alternative if you do not want surgery or are not a good candidate for it.

It can improve the appearance and function of your eyelid.

If you have ptosis, myasthenia gravis, or another condition that makes your eyelids droop, consider using a ptosis crutch.

Is It Possible To Prevent Ptosis?

It can be hard to stop ptosis because several factors may cause it.

However, you may take some steps to reduce the risk of developing ptosis.

• Maintaining good health: Regular exercise and a healthy diet can help keep your health in good shape and lower your risk of getting ptosis.
• Protecting your eyes: Wearing protective eyewear when playing sports or working with machines can help lower the chance of hurting your eyelid or the area around it.
• Avoid certain medications: Some medications can cause muscle weakness or other side effects that lead to ptosis. If you take any medication that causes droopy eyelids, you should talk to your doctor about possible alternatives.

Even if you take all these precautions, ptosis can still happen, and stopping it is not always possible.

Regular eye exams by an ophthalmologist can detect ptosis early and treat it quickly to keep it from worsening.

What Is the Long-Term Projection for People Suffering From Ptosis?

People with ptosis (droopy eyelids) can have different long-term outcomes, depending on what caused the condition, how bad it is, and how well the treatment works.

For mild cases of ptosis, the outlook is generally reasonable.

You can use eyeglasses, contact lenses, or an eye patch to improve vision and prevent amblyopia (lazy eye) in children.

Surgery is often the most effective treatment for moderate to severe cases of ptosis.

It can improve the appearance of the eyelid and restore normal vision.

But the surgery’s outcome depends on the patient’s age, what caused the ptosis, how well the levator muscle works, and if there are any other eye or nerve problems.

Suppose you have a medical condition, such as diabetes, that causes ptosis.

In that case, the long-term outlook may depend on managing that condition.