What is ptosis?
Ptosis is a condition in which one or both upper eyelids droop below their normal position. Depending on the severity, a drooping eyelid may be barely noticeable or significant enough to partially or fully obstruct vision.
The upper eyelid is held in position by the levator muscle, which contracts to raise the lid when the eye opens. When this muscle is weakened, stretched, or damaged, the eyelid can no longer maintain its proper height. Ptosis can affect one eye or both and may be present from birth or develop at any point in life.
In children, ptosis that blocks the line of sight can interfere with normal visual development. In adults, a drooping eyelid may affect both function and quality of life.
Types of ptosis
Ptosis is classified by its cause. The most common types include:
- Aponeurotic – The most common type in adults. The levator aponeurosis – the tendon that connects the levator muscle to the eyelid – stretches or disinserts over time, causing the lid to gradually lower. Age and prolonged contact lens wear are common contributing factors.
- Congenital – Present from birth due to underdevelopment of the levator muscle. Congenital ptosis ranges in severity and may require early surgical intervention to protect vision development.
- Neurogenic – Caused by a problem with the nerve signals that control the levator muscle. Conditions such as Horners syndrome, third nerve palsy, and myasthenia gravis can produce neurogenic ptosis.
- Myogenic – Results from a disease or disorder affecting the muscle itself, reducing its ability to lift the eyelid effectively.
- Mechanical – Occurs when the eyelid is weighed down or restricted by an external factor, such as a tumor, cyst, or excess skin.
- Traumatic – Develops following injury to the eyelid or surrounding structures that damages the levator muscle or its tendon.
What are the symptoms of ptosis?
The most visible sign of ptosis is an upper eyelid that sits lower than it should. Depending on the severity, symptoms may include:
One or both eyelids appearing drooped or heavy
- Reduced or obstructed field of vision, particularly in the upper visual field
- Eye fatigue or strain from unconsciously trying to raise the eyelid
- Tilting the head back or raising the eyebrows to see more clearly
- A tired or aged appearance around the eyes
- In children, amblyopia (lazy eye) or abnormal head positioning
Mild ptosis may cause no functional problems. Moderate to severe ptosis can significantly affect vision, daily activities, and driving safety.
What causes ptosis?
Ptosis develops when the structures responsible for raising the upper eyelid are weakened, damanged, or neurologically compromised. Common causes include:
- Age-related changes – The levator aponeurosis naturally stretches and weakens over decades of use. This is the most frequent cause of ptosis in adults and often develops gradually.
- Congential muscle underdevelopment – Some individuals are born with a levator muscle that did not fully develop, resulting in ptosis that is present from infancy.
- Neurological conditions – Damage to or dysfunction of the nerves that control eyelid movement can cause ptosis.
- Eye surgery or trauma – Cataract surgery, LASIK, or injury to the eyelid area can stretch or detach the levator aponeurosis, leading to ptosis that develops after the procedure or injury.
- Prolonged contact lens use – Extended use of hard contact lenses has been associated with stretching of the levator aponeurosis over rime.
- Tumors or masses – A growth on or near the eyelid can mechanically push the lid downward.
How is ptosis diagnosed?
Ptosis is diagnosed through a comprehensive eyelid and eye examination. A provider will measure the height of the upper eyelid, assess the strength and function of the levator muscle, and evaluate the degree to which the drooping lid affects the visual field.
Visual field testing may be performed to document functional vision loss cause by the drooping eyelid. In cases where a neurological cause is suspected, additional imaging or referral for neurological evaluation may be recommended.
How is ptosis treated?
Treatment depends on the underlying cause, the severity of the droop, and whether vision is affected. For most patients, surgery is the most effective long-term solution.
In select cases, nonsurgical management may be appropriate:
- Ptosis crutches – a device attached to eyeglass frames that mechanically props the eyelid open, used primarily when surgery is not an option.
- Treatment of underlying conditions – in neurogenic ptosis caused by myasthenia gravis or other systemic conditions, addressing the underlying disease may partially improve eyelid position
Droopy eyelid surgery is the definitive treatment for most forms of ptosis and is tailored to the cause and severity of the condition. An eyelid lift medical procedure of this type is considered functionally necessary when ptosis significantly obstructs vision.
Common surgical approaches include:
- Levator advancement – the most common technique for aponeurotic ptosis. The stretches or disinserted levator aponeurosis is tightened and repositioned to raise the eyelid to its correct height.
- Muller muscle resection – a less invasive approach used in mild cases, involving the tightening of a smaller muscle beneath the levator to elevate the lid.
- Frontalls sling surgery – used when the levator muscle has little to no function, particularly in congenital ptosis. A sling connects the eyelid to the frontalis muscle of the forehead, allowing the brow to assist in lifting the lid.
Ptosis repair is performed on an outpatient basis under local anesthesia in adults and general anesthesia in children. Temporary swelling and bruising are expected following surgery and typically resolve within one to two weeks. Most patients achieve a significant and lasting improvement in eyelid position and, when applicable, in their vision field.
A drooping eyelid can be easy to dismiss, especially when it develops gradually. But when ptosis starts interfering with your vision or your daily routine, it deserves attention. Our oculofacial plastic surgeons will evaluate your eyelid function and recommend the most appropriate treatment for your situation. Call 515.875.9480 to schedule an appointment today.