Approximately 11.5 percent of adults experience droopy eyelid. While many people think of it as a cosmetic issue, the condition can also affect your vision.
Droopy eyelids go by two different names: ptosis and dermatochalasis. Ptosis commonly affects your upper eyelid only, whereas dermatochalasis affects the skin both above and below your eye. Droopy eyelids can be present from birth (congenital) or appear later in life (acquired).
Determining which type you have and its underlying cause can lead you to the right treatment to help restore your vision and and provide cosmetic benefit.
There are two main types of droopy eyelids. They affect your vision in different ways. Knowing which type you have can help you work with an eye doctor to determine the best course of treatment.
Ptosis is lowering of the upper eyelid. This may prevent you from being able to fully open your eye.
Ptosis frequently results in obstruction of peripheral vision or even a limited ability to see straight ahead. Some people may have to look through their eyelashes to see.
Children may experience congenital ptosis, often due to weakness of the muscle that lifts the eyelid. Surgery is typically recommended to correct ptosis in children if it affects vision.
In these cases, the surgical correction helps support healthy eye development and prevent related vision changes like astigmatism and refractive amblyopia.
Excess eyelid skin is called dermatochalasis. People often associate this condition with looking tired or having “bags” around the eyes.
Like ptosis, dermatochalasis can also cause the eyelids to close slightly or obstruct the field of vision.
Ptosis usually involves only the upper eyelid, while dermatochalasis frequently affects both the upper and lower lids.
When your eyelid droops, it may be due to weakness in the muscles that control the eyelid or because the nerves that control those muscles aren’t working properly.
Dermatochalasis or acquired ptosis can have a number of causes. According to the American Optometric Association, these may include:
- injury to the eyelid
- damage to the nerve that controls eyelid muscles
- over-stretching of the eyelid muscles or ligaments
- eye surgery complications
Several conditions can lead to the acquired form of droopy eyelids. These include:
- third nerve palsy
- myasthenia gravis
- Horner syndrome
- muscular dystrophy
In some instances, a mass or extra skin can weigh down the eyelid.
A temporary case of ptosis can occur from botulinum toxin type A (Botox) injections in the wrong area. This usually resolves itself within a few months.
Depending on the shape of the eyelid and the severity of the droop, this condition can limit your field of vision and affect your quality of life. An ophthalmologist or optometrist can determine the kind of droopy eyelids you have and the underlying cause before coming up with a treatment plan.
Eye doctors have long offered surgical options to reduce or reverse droopy eyelids and improve vision. There’s now also a nonsurgical option that may also help some people with ptosis.
Depending on the cause of the drooping, your doctor may recommend a surgical option to help with ptosis, such as:
- Levator advancement. This is the most common approach, used for those who have typical eyelid muscle function. The procedure is done via an incision in the eyelid crease, where the surgeon tightens the connection between the eyelid and the muscle that elevates the lid.
- Mullerectomy. This is the second most common approach and can be used for mild ptosis. In this procedure, the surgeon shortens a muscle in the eyelid via an incision on the inside of the eyelid.
- Frontalis sling. This approach is usually saved for those whose eyelid muscles have reduced function. The surgeon attaches the upper eyelid to the muscle just above the eyebrows, using a silicone rod under the skin.
You may receive either sedation or general anesthesia for these types of surgeries.
Droopy eyelids classified as dermatochalasis can also be surgically repaired with a procedure known as blepharoplasty. There are two types:
- Upper eyelid blepharoplasty. The surgeon makes an incision in the crease of the upper eyelid to remove excess skin and fat and reshape the eyelid. The scar from this incision is hidden in the eyelid crease.
- Lower eyelid blepharoplasty. The surgeon makes a cut inside or on the outside of the lower eyelid to remove excess skin and fat. They may remove excess fat entirely or move it to the area between the lower lid and cheek.
Eyelid surgery for ptosis or dermatochalasis is done on an outpatient basis. Recovery time is usually 1 to 3 weeks.
In 2020, the Food and Drug Administration (FDA) approved a nonsurgical option for ptosis: a prescription eye drop called Upneeq.
The drop contains oxymetazoline, the same active ingredient used in some nasal sprays to relieve congestion. It causes the eyelid muscle to contract, lifting the lid. You use it once daily to maintain results, and it is safe for long-term use.
Upneeq won’t work on ptosis caused by reduced nerve function or certain types of injury. It also cannot help dermatochalasis resulting from excess or baggy skin.
The eyedrop is not approved for use in children or for congenital types of ptosis.
Droopy eyelids can limit your field of vision. This may happen as the result of ptosis, or the lowering of the upper eyelid. It may also be related to dermatochalasis, or excess skin around the eyes.
Droopy eyelids can obstruct your vision and reduce your quality of life. There are several surgical options for ptosis and dermatochalasis.
A prescription eye drop is a new option for some people with ptosis who elect not to have surgery.