Pathologic eyelid drooping, also called ptosis, may occur due to trauma, age, or various medical disorders. This condition can affect one (unilateral ptosis) or both (bilateral ptosis) eyes, it may come and go, or it might be permanent. It can be present at birth (known as congenital ptosis) or you can develop it later in life (known as acquired ptosis).
Depending on the severity of the condition, drooping eyelids can block or greatly reduce vision depending on how much it obstructs the pupil. In most cases, the condition will resolve, either naturally or through medical intervention.
Causes and Risk Factors
There are many different possible causes of droopy eyelids, ranging from natural causes to more serious conditions. Your doctor will also be able to help you figure out what’s causing the issue.
Anyone can get droopy eyelids, but it’s most common in older adults because of the natural aging process. A tendon attaches the levator muscle, which is responsible for lifting the eyelid. As you age, that muscle can stretch and, as a result, cause the eyelid to fall. Keep in mind, though, that people of all ages can be affected by this condition. Babies are sometimes born with it, but this is rare.
Sometimes the exact cause is unknown, but other times it may be due to trauma. It can also be neurological. The most common cause of congenital ptosis is if the levator muscle doesn’t develop properly, affecting your ability to open your eye.
Children who have ptosis may also develop amblyopia, commonly known as lazy eye. This disorder can also delay or limit their vision.
If your eyelids are drooping, it could be a sign of an underlying medical condition, especially if the issue affects both eyelids. If just one of your eyelids droops, it may be a result of a nerve injury or a temporary sty (inflammation and swelling of the eyelid that is usually harmless). Routine LASIK or cataract surgery is sometimes to blame for the development of ptosis, as a result of the muscle or tendon being stretched.
In some cases, eyelid drooping is caused by more serious conditions, such as a stroke, brain tumor, or cancer of the nerves or muscles. Neurological disorders that affect the nerves or muscles of the eyes such as myasthenia gravis can also lead to ptosis.
The main symptom of eyelid drooping is that one or both eyelids sag. In some cases, this can affect your vision. However, many people find that the eyelid sagging is barely noticeable or doesn’t happen all the time. You may also have extremely dry or watery eyes, and you may notice that your face looks weary or tired.
The main problematic areas will be around the eyes, and you may experience aching, which can also cause you to look tired. Some patients who have a severe case have to tilt their heads back at all times when speaking, even when holding a normal conversation.
A doctor should investigate persistent eyelid drooping to make sure there are no underlying conditions. This is especially important if you notice that migraine headaches or other issues have shown up since you first noticed the drooping.
Your doctor will likely perform a physical exam and ask you about your medical history. Once you have explained how often the eyelids droop and the length of time this has been happening, your doctor will run some tests to find the cause.
A slit lamp exam may be done so that your doctor can take a close look at your eye with the help of high-intensity light. Your eyes may be dilated for this exam, so you may experience some slight eye discomfort.
Another exam that can be used to diagnose issues such as eyelid drooping is the Tensilon test. Your doctor may inject a drug called Tensilon (generic name edrophonium) into one of your veins. You may be asked to cross your eyes or make other movements that use your eye muscles. Your doctor will monitor you to see if the Tensilon improves your muscle strength. This will help them determine whether muscle issues are causing the eyelid drooping.
The treatment for eyelid drooping depends on the specific cause. If the condition is the result of age or is something you were born with, you may not receive treatment. Your doctor may explain that nothing needs to be done because the condition is not usually harmful to your health. However, you may opt for plastic surgery if you want to reduce the drooping.
If your eyelid blocks your vision, you will need medical treatment. Your doctor may recommend surgery. Glasses that can hold the eyelid up are another option. This treatment is often most effective when the eyelid drooping is only temporary so that you don’t have to wear the glasses all the time. Glasses may also be recommended if you aren’t a good candidate for surgery.
Your doctor may recommend ptosis surgery. During this procedure, the levator muscle is tightened. This will lift the eyelid up into the desired position. Another alternative is a “sling” operation, in which the forehead muscles are used to elevate the eyelids.
For children who have ptosis, doctors sometimes recommend surgery in order to prevent the onset of amblyopia or lazy eye.
If your doctor finds that your eyelid drooping is caused by an underlying condition, you will likely be treated for that. This should typically stop the eyelids from sagging.
There is no way to prevent eyelid drooping. Just knowing the symptoms and getting a regular eye exam can help you fight the disorder. If you notice that your child seems to have a drooping eyelid, take them to the doctor right away to be treated and monitored. Since it can affect your vision, which can affect your driving ability and other activities, you should take it seriously. You may be able to stop it from getting worse by seeing a doctor right away.
Eyelid drooping isn’t usually harmful to your health. However, if your eyelids block your vision, you should avoid driving until the condition has been treated. Your long-term outlook will depend on the cause of the eyelid drooping. Most of the time, the condition is just a cosmetic issue. However, since droopy eyelids can sometimes be a sign of a more dangerous condition, always consult your doctor first.