Ptosis (Droopy Eyelid): Causes, Symptoms, and Treatment Options 

A droopy eyelid can change how the world sees you. It can also affect how you see the world. Ptosis is more than a cosmetic concern—it may cause vision problems, discomfort, or even strain. Some are born with it. Others may develop it over time. Fortunately, medical advances offer solutions. 

What is Ptosis?

Ptosis is a condition where the upper eyelid droops lower than normal. It may affect one eye or both. In mild cases, the eyelid droops slightly. In severe cases, it can cover the pupil and block vision.

Types of ptosis

Ptosis is not the same for everyone. Doctors classify it into different types to determine the best treatment.

Congenital ptosis

Some babies are born with a droopy eyelid. This happens when the levator muscle does not develop properly before birth. It can be hereditary in some cases. It can affect vision and lead to a condition called lazy eye (amblyopia) when it is serious. 

Acquired ptosis

Acquired ptosis develops later in life. It may result from ageing, muscle weakness, nerve damage, or an underlying health issue. There are five main types:

1. Aponeurotic ptosis – The most common type in adults. It occurs when the levator muscle stretches or detaches, often due to ageing or prolonged use of rigid gas permeable (RGP) contact lenses.
2. Neurogenic ptosis – Caused by nerve-related issues, such as Horner’s syndrome or third nerve palsy.
3. Myogenic ptosis – Muscle disorders like myasthenia gravis can weaken the eyelid muscles, leading to ptosis.
4. Mechanical ptosis – A heavy eyelid due to swelling, tumours, or excess skin can cause drooping.
5. Traumatic ptosis – Injury to the eye or surrounding structures can damage the levator muscle and lead to ptosis.

Each type requires a unique approach. Identifying the cause helps doctors choose the right ptosis treatment for better outcomes.

How common is ptosis? 

Ptosis can affect anyone, from newborns to older adults. While exact numbers vary, studies suggest that congenital ptosis is rare, affecting about 1 in 800 to 1,000 births. Most cases occur in only one eye, but some children are born with drooping in both.

Acquired ptosis is more common and tends to appear with age. The levator muscle, which lifts the eyelid, weakens over time. Research indicates that aponeurotic ptosis—caused by ageing—is the most frequent type in adults. 

Symptoms and Causes of Ptosis 

Ptosis often develops gradually, making early signs easy to miss. However, in some cases—such as neurogenic or traumatic ptosis—it may appear suddenly. The most obvious symptom is a droopy eyelid, but other changes can also occur.

The common symptoms are the following:

1. One or both eyelids sag lower than usual.
2. Vision may become partially blocked if the eyelid covers the pupil.
3. Frequent headaches or eye strain due to excess effort in lifting the eyelids.
4. Raising eyebrows or tilting the head back to see better.
5. Uneven or tired-looking eyes, even when fully awake.
6. In children, congenital ptosis can lead to lazy eye (amblyopia) if left untreated. This may cause permanent vision problems.

As regards the causes of ptosis, several factors can weaken the levator muscle and cause drooping.

Ageing – The most common cause. The muscles stretch over time, making the eyelid droop.

Congenital weakness – Underdeveloped eyelid muscles present at birth.

Nerve damage – Neurological conditions like third nerve palsy or Horner’s syndrome can affect eyelid movement.

Muscle disorders – Conditions such as myasthenia gravis interfere with muscle strength and control.

Eye trauma or surgery – Injury or previous eyelid surgery can weaken the levator muscle.

Decoding the cause helps doctors choose the right ptosis treatment. If sudden drooping occurs, medical attention is essential. This is because it could indicate an underlying health condition.

Ptosis (Droopy Eyelid) Diagnosis and Tests

Diagnosing ptosis involves a detailed eye examination. Doctors assess eyelid position, muscle strength, and any related vision problems. Identifying the underlying cause helps determine the best ptosis treatment.

• Clinical examination: An eye specialist will check how much the eyelid droops and whether it affects vision. They measure eyelid height, muscle function, and how the eyes move. In children, doctors look for signs of congenital ptosis and its impact on vision development.
• Some diagnostic tests may be conducted, too. They can include slit-lamp examination, where a magnified view of the eye helps detect nerve or muscle abnormalities. The ice pack test and neostigmine tests are used if myasthenia gravis is suspected, as this condition can cause fluctuating eyelid drooping. Visual field test checks whether the drooping blocks peripheral vision. CT or MRI scan is performed if nerve damage, tumours, or other neurological issues are suspected.

Treatment Options for Ptosis

The right ptosis treatment depends on the severity of the condition and its cause. Some cases require surgery, while others improve with non-surgical approaches.

The non-surgical approaches include:

• Ptosis crutches – Special attachments on glasses lift the eyelid, helping people who cannot undergo surgery.
• Treating Underlying Conditions – If nerve or muscle disorders cause ptosis, treating the root issue may reduce drooping.

That being said, surgical correction is the most effective option for moderate to severe cases. The goal is to strengthen or shorten the eyelid muscles for better lifting. They can be of three types:

• Levator resection – The levator muscle is tightened to lift the eyelid to a normal position.
• Frontalis sling surgery – Used when the levator muscle is too weak. A small sling connects the eyelid to the forehead muscle, allowing the forehead to lift the lid.
• Müller’s muscle resection – Suitable for mild ptosis, this procedure adjusts a smaller muscle inside the eyelid. It is only effective if the eyelid adequately responds to a phenylephrine test.

Surgical results are usually long-lasting, restoring both vision and appearance, though ptosis may sometimes recur due to progressive tissue laxity or if neurological/ muscle disorder.

Prevention of Ptosis

Not all cases of ptosis can be prevented, but some steps can lower the risk. 

Protecting the eyelid from injury reduces the chances of droopy eyelid development. 

Regular eye check-ups help detect early signs, especially for those with neurological conditions. 

Avoiding prolonged use of RGP contact lenses may prevent muscle strain. 

A healthy lifestyle supports muscle and nerve function, reducing age-related ptosis causes. 

Avoid excessive rubbing of eyes.

If sudden drooping occurs, it may indicate an urgent neurological condition and requires immediate medical advice.

Tackling Ptosis

Ptosis affects both appearance and vision, but effective treatments exist. Early diagnosis improves outcomes, whether through non-surgical methods or ptosis surgery. Seeking expert care ensures the best outcome.