How can you treat a droopy eyelid, and what causes it?

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Eyelids can droop in different ways. Sometimes, the droop is only slight and does not cause any problems. In other cases, however, the eyelid may droop enough to cover the pupil and restrict a person’s sight.

If a person has a slight droop to their eyelids, the issue is often cosmetic. This may mean that the person is unhappy about the appearance of their eyelid but that the ptosis does not affect the way their eye functions.

When the eyelid droops farther, the problem may become functional, possibly restricting the person’s ability to see.

A person may develop ptosis for several reasons. It can sometimes begin during childhood, but it often develops with age.

The eyelids may droop if the muscle in the eyelid separates or stretches away. It may also develop due to an issue with the eyelid nerves.

The main symptom of having droopy eyelids is the upper eyelid drooping lower than usual. Another symptom is the creases on the upper eyelids not appearing symmetrical between the right and left eye.

In some cases, a droopy eyelid may resolve spontaneously. If ptosis is present but not causing any functional problems, a person may not need any treatment at all.

Treatment options depend on what is causing the droopy eyelid, how it is affecting the person, and the person’s age.

When a child has a droopy eyelid, for example, doctors often recommend surgery. This is because the droopy eyelid is more likely to affect the child’s vision.

Before suggesting how to manage ptosis, a doctor may assess the person using the following:

• imaging tests
• blood tests
• a complete eye exam

These assessments will help them determine the best treatment.

Managing ptosis may involve surgery, but there are also some nonsurgical treatment options available. These include:

• prescription eye drops
• specialized glasses to strengthen the eyes
• medication

Daily doses of the medication oxymetazoline can affect the levator muscle.

A doctor may suggest trying these options before they recommend surgery.

There are several types of surgery a person may undergo for ptosis, depending on the cause.

Frontalis sling procedure

If the problem is with the function of the levator muscle, a common surgical option is a frontalis sling procedure. This operation involves the frontalis muscle, using the forehead muscle to control the upper eyelid.

The frontalis sling procedure is a popular option for myogenic ptosis, which the section below will look at in more detail.

Levator resection

Another procedure for poor levator function is levator resection. This involves shortening the levator muscle.

If the ptosis is mechanical, such as from added weight on the eyelid, the surgeon may also remove the extra mass and any additional skin on the eyelid.

Other surgical options

Levator aponeurosis advancement and Fasanella-Servat Mullerectomy are two other surgical options. Doctors may recommend these options for people with droopy eyelids that are not related to levator muscle function.

What to expect

Most surgeries for ptosis are outpatient procedures, meaning that the person can go home on the same day of the operation.

Though unlikely, there are some risks associated with ptosis surgery. These include:

• bleeding
• infection
• undercorrection
• overcorrection
• reduced or blurred vision

A doctor will only recommend a surgical procedure if the ptosis is affecting a person physically, such as by reducing their vision.

Some factors that can cause droopy eyelids include:

• aging
• eye injuries, including trauma
• surgery to the eyes
• tumors

The way an eyelid droops often depends on the type of ptosis the person has. The sections below will describe a few different types of ptosis.

Aponeurotic ptosis

Aponeurotic ptosis is the most common form of droopy eyelid. It usually develops with age, often starting when a person is in their 50s or 60s.

It is less common for a person to develop aponeurotic ptosis during their younger years, but this is possible.

The condition may start to develop after a trauma to the eye, or it may result from surgery or from wearing contact lenses for a long period of time.

Neurogenic ptosis

Neurogenic ptosis occurs when there are problems with the nerve pathways in the eyelid muscles. This type of ptosis often results directly from conditions such as Horner syndrome or third cranial nerve palsy.

Indirectly, neurogenic ptosis can develop from tumors, diabetes, multiple sclerosis, or carotid-cavernous aneurysms.

Myogenic ptosis

Myogenic ptosis develops when the levator muscle, which is responsible for moving the eyelid, stops working properly. The muscle becomes unable to lift the eyelid into position.

This type of ptosis usually affects other elements of a person’s facial expression in addition to their eyelids.

Mechanical ptosis

Some people develop ptosis because the eyelid becomes too heavy to control.

This added weight may be from fat or from skin. It may also happen if there is a tumor on the eyelid.

Pseudoptosis

To some extent, the cause of ptosis often comes from a problem with the levator muscle. However, when a droopy eyelid develops because of other factors, it is called pseudoptosis.

Pseudoptosis may develop from the condition blepharospasm, which causes uncontrollable blinking or eye twitches. It may also develop from hemifacial spasm, which is a nervous system disorder that affects one side of the face.

When a doctor is determining the cause of droopy eyelids, they will consider:

• the person’s age
• any medical conditions they have
• the severity of the eyelid droop
• their levator muscle function

To assess the levator muscle function, a doctor will measure the distance the eyelid travels when the person goes from an upward gaze to a downward gaze.

Determining the cause of the droopy eyelid helps them decide how best to treat it.

Some people may develop ptosis as a normal part of aging. However, if a child’s eyelids become droopy or a person has concerns about their eyelids, it is best to see a doctor in case these issues start to affect their vision.

A person should see a doctor if:

• their eyes keep tearing up
• their vision becomes blurry
• they have a more tired appearance

In less common cases, droopy eyelids may signal an underlying medical condition, such as an issue with the nerves, muscles, or brain.

Droopy eyelids occur when the upper eyelid hangs downward more than usual. The medical term for this drooping is ptosis.

Droopy eyelids are sometimes normal, often developing with age. However, if the droop is severe, it can affect the function of the eye and may restrict vision.

The best treatment option for droopy eyelids depends on what is causing them. If a person’s droopy eyelids are causing a functional problem, a doctor may recommend one of several treatment options. These may be surgical or nonsurgical.

If a person is concerned about droopy eyelids, they may wish to consider speaking to a doctor.