Ptosis is the medical term for a drooping eyelid. It refers only to the upper eyelid; it does not refer to lower eyelid sagging. Upper eyelid drooping can sometimes affect your vision if the drooping is severe. Ptosis is not a disease, but a symptom of another condition that must be treated.
Ptosis can be caused by a number of factors that affect the muscles, nerves, or skin of the eyelids. The muscles that allow your eyelids to move up and down—called the levator muscles—can become weakened from age or injury. In addition, some people may be born with weaker-than-normal eye muscles, thereby developing ptosis at a young age.
Nerve damage can contribute to ptosis as well. A common cause of ptosis is Horner syndrome. Horner syndrome is a form of nerve damage that occurs in the face and eyes, and is usually the result of an underlying condition. Stroke and other brain injuries, spinal cord injuries, and some forms of lung cancer can cause Horner syndrome and ptosis.
Some chronic conditions, including diabetes and myasthenia gravis, may also increase your risk of ptosis. Diabetes—your body’s inability to process sugar correctly—can lead to a number of complications, including eye disease. Myasthenia gravis is an autoimmune disease that affects the way your muscles and nerves communicate.
Cluster headaches can also cause ptosis in some people. Cluster headaches are severe headaches that strike in a frequent pattern for a period of time (cluster periods) and then go into remission.
The primary symptom of ptosis is a visible drooping of the upper eyelid. Ptosis can affect children and adults at any stage of life. You may notice symptoms in one or both eyes. Individuals who are born with drooping eyelids have congenital ptosis. One of the signs of congenital ptosis is having uneven creases in the eyelids.
Children who have ptosis may use certain gestures or body positions common to people with this symptom. Frequent eyebrow raising and head tilting can indicate that ptosis is interfering with normal sight.
The American Academy of Ophthalmology stresses the importance of eye exams for children and adults with ptosis (EyeCare America). A vision test that uses an eye chart can help determine if eyelid drooping is compromising your or your child’s vision.
Blood tests used to detect diabetes and autoimmune conditions can help diagnose the underlying cause of ptosis. Your doctor may also perform X-rays to see if structural abnormalities around the eye(s) are causing the problem.
Treatment for ptosis varies. If diabetes is the cause, your doctor will teach you how to manage this condition. Drooping eyelids caused by spinal cord injuries, tumors, nerve damage, or cancer may resolve once the underlying condition is addressed.
If myasthenia gravis is to blame, you doctor will likely prescribe medication to ease ptosis and other symptoms of this disease. Medications, such as neostigmine and pyridostigmine, may help your muscles and nerves to work together more effectively. Your doctor may also prescribe prednisone or other immunosuppressant drugs.
In cases of congenital ptosis, the levator muscles usually do not improve on their own, and may require surgery. Surgical repair involves manually tightening the levator muscles in order to lift the eyelid. You may have trouble opening and closing your eye immediately after surgery, but as you recover, this function will return. An eyelid lift can restore normal vision in many cases.
Children who have ptosis are at an increased risk for developing a lazy eye. Lazy eye, called amblyopia, is the blurring or absence of vision in one eye. Amblyopia occurs when the nerve connections between your brain and eye are impaired. One treatment for this condition involves putting a patch over your good eye in order to make your poor eye work more efficiently. Surgical repair for ptosis can help prevent lazy eye.
The underlying cause of ptosis plays a major role in determining the outlook for individuals with this condition. Surgery can be very successful in restoring vision and eye function, as well as the appearance of the eye. In some cases, however, even after surgery your eyelids may not look entirely symmetrical.