Drooping Eyelid (Ptosis): What’s Causing It & More

A drooping eyelid may be a natural part of aging or a symptom of an underlying medical condition.

People typically leave their eyelids alone when there’s only a slight sag.

However, when the droop is severe or starts to affect vision, you might be more eager to find a solution.

In this article, I’ll discuss drooping eyelids, the possible causes, and their symptoms.

Then, I’ll outline the risk factors and how health care providers diagnose the condition.

Next, I’ll talk about treatment and preventive measures. Finally, I’ll explain when to see a health care provider.

What Is a Drooping Eyelid (Ptosis)? 

Drooping eyelid, also known as ptosis or blepharoptosis, is when the upper eyelid is in a lower position than average.

In some cases, even though the eyelid is lower, it’s not really noticeable and does not impact vision while in other instances, it may partly cover the pupil and make it difficult to have clear vision. 

Ptosis may affect one eye, in the case of unilateral ptosis, or it may affect both eyes in bilateral ptosis.

Ptosis can happen in both children and adults.

When it is present at birth, it is called congenital ptosis and is usually a developmental problem with the muscle responsible for raising the upper eyelid.

If it happens later in life, it is called acquired ptosis.

Causes

A drooping eyelid can have a natural explanation, but it may also be caused by a serious health condition when it happens suddenly over a few days.

The possible causes of drooping eyelid include:

Aging 

Drooping eyelids become more common as you get older.

The skin and tissue around the muscle elevating the upper eyelid stretch and weaken with age.

As a result, the skin of the eyelid loses its elasticity and starts to droop.  

Nerve damage 

Oculomotor nerve palsy, also called third nerve palsy, occurs when there is damage to the third cranial nerve.

This nerve controls the movement of the eye muscle, the position of the upper eyelid, and the constriction of the pupil.

When there is damage to it, it may cause drooping of the eyelid. 

Third nerve palsy may be congenital, which is the most common cause in children.

It can also be caused by head trauma, certain infections, strokes, the presence of a tumor or an aneurysm, or other causes.

Horner syndrome 

Horner syndrome results from paralysis of specific nerves that affect one side of the face.

The symptoms typically include a drooping eyelid, a decrease in pupil size, and decreased sweating, all on the affected side of the face. 

In addition, if this syndrome occurs in children less than two years old, the colored part of the eye on the affected side usually has a lighter color than the other eye, a condition known as iris heterochromia.

Although Horner syndrome can be genetic, the nerve paralysis that leads to it may have an underlying life-threatening cause, such as a tumor.

Injury 

An injury to the eyelid can weaken the muscle responsible for raising the eyelid.

Diabetes 

Diabetes is a chronic condition that affects the body’s ability to process blood glucose, leading to high blood sugar levels.

This increased blood sugar can gradually damage nerves in and around your eyes, which may cause drooping eyelids and optic problems like double and blurred vision. 

Myasthenia gravis 

Myasthenia gravis is a chronic autoimmune disease that causes weakness in the muscles of the body, especially those that control the eye and eyelid movement.

In this case, drooping may be mild or severe and may occur in one or both eyelids.

People with myasthenia gravis can also experience double vision due to a lack of balance in eye movement.

Previous surgery 

A drooping eyelid can result from a complication from eye surgery, such as a routine cataract or LASIK surgery.

It may be caused by eyelid swelling or the stretching of the muscle.

In this case, it often does not last long.

If it does last, it will require medical intervention.

Tumors or cysts 

A brain tumor can cause drooping eyelids if it affects the muscles and nerves connected to the eyes.

Cysts like a chalazion, a painless lump usually on the upper eyelid, can also cause the eyelid to droop.

Even though the muscle that elevates the eyelid is functioning well, the extra weight on the eyelid can cause it to droop.  

Symptoms 

A drooping eyelid is typically painless, and sometimes it is so slight that it is almost unnoticeable. 

When the sag is noticeable, associated symptoms include: 

• Decreased upper field of vision

• Completely blocked vision if the eyelid covers the pupil

• Consistent tired look 

• Tilting of head back to see clearly

• Extremely dry or watery eyes

• Aching around the eyes 

A constantly raised eyebrow might also be a symptom since raising the brows is a reflexive way of correcting the droopy eyelid.

This may cause a headache at the end of the day since the forehead muscle is strained.

Risk Factors 

The risk factors for drooping eyelid include:

• Age
• Eye surgery
• Excessive eye rubbing
• Genetics
• Presence of other medical conditions

Diagnosis 

Your healthcare provider will examine the appearance of the eyelid.

Depending on the exam findings, different tests may be indicated to figure out the underlying cause.

These tests may include referral to an eye specialist, brain or orbit imaging with a CT scan or MRI, or specific tests for conditions like myasthenia gravis.

Treatment 

In most cases, aging is the cause of drooping eyelids.

Treatment is usually not necessary if it does not impair vision.

However, patients might still want to get treatment for aesthetic reasons. 

If ptosis prevents clear vision, your healthcare provider may recommend surgery where the muscle responsible for lifting the eyelid is tightened.

Your provider may also recommend a ptosis crutch, special glasses with a bar that pushes the eyelid upward when it is worn.

In the case of underlying medical conditions, treatment is specific to the condition.

For oculomotor nerve palsy, if it is congenital, there is no treatment for it, but if it is acquired, surgery to relieve the pressure caused by a tumor or blood vessel may improve the condition. 

For diabetes, the drooping eyelid may improve if diabetes is kept under control.

However, if there is no improvement and the drooping eyelid impairs the person’s vision, your healthcare provider may suggest surgery.

Myasthenia gravis is a chronic, lifelong condition that can be managed with medication or a surgical procedure called a thymectomy.

Prevention 

There is no proven way to prevent drooping eyelids.

Congenital ptosis occurs at birth, and acquired ptosis is usually due to natural aging or an underlying medical condition.

When To See a Medical Provider 

If the drooping eyelid affects your vision or you’re concerned about your appearance, you might need to seek medical attention. 

If the drooping occurs suddenly and progresses quickly, or is accompanied by any other symptoms, it is typically a sign of an underlying medical condition.

If you also experience symptoms such as double vision or pain, contact your doctor or primary care provider immediately.

How K Health Can Help 

Have you experienced sudden drooping of your eyelid? You may need to speak with a provider. Did you know you can get affordable primary care with the K Health app?

Download K Health to check your symptoms, explore conditions and treatments, and if needed text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.