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Ptosis: Droopy Eyelid Causes and Treatment

What is ptosis?

Pathologic droopy eyelid, also called ptosis, may occur due to trauma, age, or various medical disorders. This condition is called unilateral ptosis when it affects one eye. It’s called bilateral ptosis when it affects both eyes. It may come and go, or it might be permanent. It can be present at birth, where it’s known as congenital ptosis, or you can develop it later in life, which is known as acquired ptosis.

Depending on the severity of the condition, droopy upper 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.

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Causes

Who gets droopy eyelid?

There are many different possible causes of droopy eyelids, ranging from natural causes to more serious conditions. Your doctor will be able to help you figure out what’s causing the issue.

Anyone can get droopy eyelids, and there aren’t substantial differences in prevalence between men and women or between ethnicities. However, it’s most common in older adults because of the natural aging process. The levator muscle 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. Though rare, babies are sometimes born with it.

Sometimes the exact cause is unknown, but other times it may be due to trauma. It can also be neurological.

Children

The most common cause of congenital ptosis is the levator muscle not developing properly. Children who have ptosis may also develop amblyopia, commonly known as lazy eye. This disorder can also delay or limit their vision.

Risk factors

What are the risk factors for droopy eyelid?

Certain medical conditions can also put you at risk for developing droopy eyelid.

Medical conditions

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 stye. Routine LASIK or cataract surgery is sometimes to blame for the development of ptosis, as a result of the muscle or tendon being stretched.

Serious conditions

In some cases, droopy eyelid 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.

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Symptoms

What are the symptoms of droopy eyelid?

The main symptom of droopy eyelid is that one or both upper 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 people with severe ptosis may have to tilt their heads back in order to see at all times when speaking, even when holding a normal conversation.

A doctor should investigate persistent droopy eyelid 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.

Diagnosis

How is droopy eyelid diagnosed?

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 performed 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 droopy eyelid is the Tensilon test. Your doctor may inject a drug called Tensilon, known generically as edrophonium, into one of your veins. You may be asked to cross and uncross your legs or stand up and sit down several times. Your doctor will monitor you to see if the Tensilon improves your muscle strength. This will help them determine whether a condition called myasthenia gravis is causing the droopy eyelid.

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Treatment

How is droopy eyelid treated?

The treatment for droopy eyelid depends on the specific cause and the severity of the ptosis. 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 doctor finds that your droopy eyelid is caused by an underlying condition, you will likely be treated for that. This should typically stop the eyelids from sagging.

If your eyelid blocks your vision, you will need medical treatment. Your doctor may recommend surgery. Glasses that can hold the eyelid up, called a ptosis crutch, are another option. This treatment is often most effective when the droopy eyelid is only temporary. Glasses may also be recommended if you aren’t a good candidate for surgery.

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. For children who have ptosis, doctors sometimes recommend surgery in order to prevent the onset of amblyopia or lazy eye.

However, there are risks associated with surgery, including dry eye, a scratched cornea, and a hematoma. A hematoma is a collection of blood. Moreover, it’s not uncommon for surgeons to place the eyelid too high or too low.

Another alternative is a “sling” operation, in which the forehead muscles are used to elevate the eyelids.

Ptosis crutch

The ptosis crutch is a nonsurgical option that involves adding an attachment to the frames of your glasses. This attachment, or crutch, prevents drooping by holding the eyelid in place. There are two types of ptosis crutches: adjustable and reinforced. Adjustable crutches are attached to one side of the frames, while reinforced crutches are attached to both sides of the frames. Crutches can be installed on nearly all types of eyeglasses, but they work best on metal frames. If you’re interested in a crutch, consult an ophthalmologist or plastic surgeon who works with people with ptosis.

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Prevention

Is it possible to prevent ptosis?

There’s no way to prevent droopy eyelid. 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 droopy eyelid, take them to the doctor right away to be treated and monitored. Since it can affect your vision, you should take it seriously. You may be able to stop it from getting worse by seeing a doctor right away.

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Outlook

What’s the long-term outlook for people with ptosis?

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 droopy eyelid. 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.

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