Droopy eyelids (ptosis): symptoms, causes and treatments

Ptosis, which in Greek means “to fall”, refers to drooping of the upper eyelid over the eye. It can affect one or both eyes to varying extents. It may be subtle with only a small amount of drooping or it can be severe enough to limit your vision. 

There are two main types of ptosis: congenital ptosis and acquired ptosis.

Congenital ptosis, where drooping is present from birth or occurs in the first year of life, affects fewer than 0.5% of children in the UK. Acquired ptosis, which occurs in adults, affects around 5–13.5% of adults in the UK. 

Ptosis symptoms

Whether ptosis occurs in childhood or adulthood, the main symptom is drooping of the upper eyelid. As a consequence, you may raise your eyebrows to help lift up your eyelids, tilt your head or lift your chin to help you see better. This can lead to head and neck problems, and wrinkles on your forehead.

In children, ptosis can lead to a lazy eye, medically known as amblyopia, as their vision is still developing. The eye that has ptosis will be weaker or ‘lazy’ and consequently, you may notice that the eye wanders inward or outward. If a lazy eye is not treated, it can lead to a permanent decrease in vision.

Other symptoms of ptosis relate to cosmetic appearance. If you have ptosis, you may appear to look sleepy and/or have an asymmetry in the appearance of your eyelids. This can affect your self-esteem and consequently, your quality of life.

Causes of ptosis

Congenital ptosis, which occurs from birth or in the first year of life, is caused by poor development of the levator muscle. This is the muscle that lifts the eyelid.

Acquired ptosis, which occurs in adulthood is usually due to ageing, where the levator muscle is stretched or detaches from the tarsal plate, a piece of cartilage that the muscle is usually attached to.

Other causes of acquired ptosis include degenerative muscle conditions (myopathies), damage to nerves that supply the eyelids, trauma to the eye and tumours in this area.

Preventing ptosis

In the majority of cases, ptosis can’t be prevented as it is the result of a developmental problem or ageing. 

However, higher rates of ptosis have been found in those who wear contact lenses, and/or have diabetes or high blood pressure. Following a healthy lifestyle and wearing glasses instead of contact lenses if you need vision correction can, therefore, help reduce your risk. 

As ptosis can also be caused by tumours in the eye area, you can reduce your risk of ptosis by reducing your risk of tumours of the eyelid ie by protecting your eyes from the sun’s damaging UV rays, especially on days when the UV index is high. You can wear high SPF sunblock, wraparound sunglasses and brimmed hats. 

In cases where ptosis is caused by eye trauma, you can reduce your risk by wearing protective eyewear when playing sports or performing activities (eg DIY) that put your eye at risk of injury. 

Diagnosing ptosis

If you’re concerned that you have ptosis, see your GP or optician. Following an examination, if appropriate, they will refer you to see a doctor who specialises in treating eye conditions (an ophthalmologist). Within the speciality of ophthalmology, there are also ophthalmologists who subspecialise in treating the eyelids, who are best placed to treat ptosis (oculoplastics specialists).

Your ophthalmologist will ask you about your medical history and symptoms before performing an examination of your eyelids, pupils and eye movement. They will also measure and assess the function of your levator muscle. Based on these results, you will receive a diagnosis and advice on the most suitable course of treatment.

Treating ptosis

Ptosis is treated with surgery.

In children, where ptosis is caused by poor development of the levator muscle, surgery involves a brow suspension procedure, where the eyelid is lifted by attaching it to the frontalis muscle in the brow. The child then learns how to use their brow to lift their eyelid further.

In adults, age-related acquired ptosis is most commonly treated with a type of surgery called a levator muscle advancement. The levator muscle is isolated from any tissue above and below it, brought forward and then reattached to the eyelid. This lifts the eyelid back to normal height.

Risks of ptosis correction surgery

Every surgery comes with risks, such as bleeding, bruising, infection and nerve damage.

Surgery to correct ptosis, specifically, comes with the risk of dry eye syndrome if the eyelid is lifted too high so that the eye can’t close properly.

There is also the risk of damage to the eye, your eyelids still appearing asymmetrical and/or a visible scar — most scars are hidden in the eyelid crease where they aren’t visible.

The procedure may also fail, so you may need further surgery. However, in the majority of cases, surgery to correct ptosis is successful both in terms of improving appearance and vision.