Drooping Eyelids (Ptosis): Causes, Risks, Treatments

Ptosis (TOE-sis) is the medical term for droopy eyelids. It can affect one or both eyes and be mild enough that it doesn’t interfere with vision or so severe the person’s vision may be highly impaired.

Also called blepharoptosis, the condition can be congenital, meaning present at birth, or acquired, which means the ptosis occurred later in life. In the United States, about one in 842 babies is born with some degree of ptosis.

This type of ptosis most commonly occurs in people aged 50 and above, but it can happen to anyone. The condition is fairly often present as part of the normal aging process. People who begin to develop ptosis earlier in life may experience even more significant drooping as their skin’s elasticity continues to degrade.

Types of Ptosis and Their Causes

Congenital Ptosis

This is typically present at birth, although any ptosis appearing within the first year of life may also be classified as congenital. When seen in newborns and infants, the cause is a faulty eyelid muscle called the levator muscle.

If you think of the word levitate, which means to rise, you will begin to see where this muscle got its name. The levator muscle in the upper eyelid helps to pull the eyelid up. In congenital ptosis, this muscle fails to develop normally during prenatal life.

In nearly three-quarters of babies with this condition, only one eye is affected. Most of the time, the cause of congenital ptosis remains unknown, but there may be a genetic factor in some children.

If left untreated, ptosis can threaten a child’s visual development and lead to amblyopia or lazy eye. This may occur when the brain begins to ignore incoming signals from the hooded eye, possibly because the signals are confusing and don’t match the complete information coming from the normal eye.

Untreated ptosis may cause head and neck pain from the child’s constant attempts to see upwards through the drooping eyelid.

The condition can impair a child’s social development as they begin school if other children mock, deride, tease, and even shun them because of ptosis.

Since ptosis is highly treatable with surgery, there is no need for any possible consequences of untreated ptosis.

There are five main types of Acquired Ptosis

Traumatic Ptosis

This results from an eye or facial injury involving the eyelids. Depending on the degree of damage, it may heal on its own or require surgery.

Mechanical Ptosis

This occurs when a growth or stye on the eyelid stretches the levator muscle or impairs it enough to cause eyelid drooping. Surgery is often necessary to remove the growth, although this may not be performed until the degree of drooping interferes with vision.

Myogenic Ptosis

The prefix myo- refers to a muscle. The suffix -genic roughly means “originating from.” This means that myogenic ptosis is related to a muscle in some way. For example, myocarditis is an inflammation of the heart muscle.

A group of mainly inherited muscular wasting diseases called muscular dystrophy is an example of a myogenic cause of ptosis. Muscular dystrophy causes a degeneration of the body’s muscles over time, including the levator muscle in the upper eyelid.

Neurogenic Ptosis

This term means “originating in the nerves.” When the nerves controlling the eyelid are affected by neurological conditions like myasthenia gravis, third nerve palsy, or Horner syndrome, ptosis may occur.

Both myogenic and neurogenic ptosis would likely be treated by controlling the underlying condition, which should also relieve the ptosis.


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Aponeurotic Ptosis

Most people with ptosis have this type. This occurs as part of the aging process in some individuals. A general breakdown of the skin’s connective tissue called elastin causes the levator muscle to weaken and stretch too far.

Eye rubbing can accelerate and worsen it. Learn to refrain from rubbing at itchy or irritated eyes and consult with your eye doctor for treatment to relieve the problem.

Since ptosis, especially that which appears suddenly, can indicate a serious problem, such as cancer, brain tumors, or a current or impending stroke, it should always be evaluated by an eye doctor right away.

Ptosis Symptoms

The hallmark symptom is, of course, an eyelid that droops. People with ptosis may tilt their heads back or repeatedly raise their eyebrows in an attempt to raise their eyelids.

Ptosis from aging can be very subtle. If you think you may have it, compare a current photo of yourself with one taken 10 to 20 years ago. Any drooping will become apparent if it is there.

Ptosis can mimic another disease called dermatochalasis. This is an actual deficiency of the skin’s supporting protein elastin.

Treatment of Ptosis

Since there is such a wide variety of possible ptosis causes, treatment partly depends on the cause and degree. Very mild ptosis may be barely noticeable by others and may not compromise vision at all. These cases likely need no intervention.

The line is drawn when the condition impedes vision. Ptosis surgery is usually successful when performed by an experienced eye surgeon. The surgeon typically tightens the levator muscle and may also remove excess skin and fat.

Rarely, this will not be sufficient. In those cases, the surgeon may perform a procedure using forehead muscles to assist the levators.

Children with ptosis significant enough to affect vision should receive corrective surgery as soon as possible to prevent the development of a lazy eye, which would in itself need treatment.

Adults and children with ptosis but without visual impairment may elect to have a surgical correction for purely cosmetic reasons.

Surgical Risks

It’s imperative to find an experienced eye surgeon who has done many of these procedures. Don’t be shy: Ask your prospective eye surgeon how many procedures they have done, whether they’re board-certified, and about their complication rate.

Ask to see before and after photos of previous patients. It’s standard for a surgeon to have these kinds of images available, so your doctor should provide them willingly and even without being asked. Reputable doctors are proud of their work and love to display it.

Surgery risks include asymmetry of the eyelids when compared to one another. This simply means that one eyelid may be higher than the other and a failure of one or both eyelids to close all the way. This can cause dry eye and other serious problems.

Other possible complications include a loss of eyelid functionality and overall dissatisfaction with the cosmetic results.

Ptosis is correctable but not technically curable since drooping may reoccur in the future. However, surgery for ptosis generally provides a long-lasting result.

When Ptosis may be Serious

You should seek medical treatment immediately if any of these symptoms occur:

1. Drooping eye with severe headache, problems with speech, blurry vision, and muscle weakness in the arms, legs, or face

2. A suddenly appearing or rapidly worsening droopy eyelid

3. Eye pain, redness, difficulty moving the eye, and fever

Parents should watch their children carefully for signs of the condition. Adults with age-related ptosis may discuss individual options with their eye doctor.

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