Droopy Eyelids - Ptosis
Ptosis is the drooping of the upper eyelid, which can affect vision, appearance and eyelid function. Learn the symptoms, causes, diagnosis and when treatment is required.
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Denise DouthwaiteWhat Is Ptosis?
Ptosis (pronounced toe-sis) refers to a drooping upper eyelid that sits lower than normal. It can affect one eye or both, and range from mild to severe. When the lid droops enough to cover part of the pupil, it can significantly reduce the upper field of vision and cause functional problems such as eye strain, headaches, and difficulty reading.
Ptosis may be present at birth (congenital ptosis) or develop later in life (acquired ptosis). Adult ptosis is most commonly caused by weakened or stretched eyelid muscles, particularly the levator muscle, which is responsible for lifting the upper lid.
In some cases, ptosis may worsen throughout the day as the muscles tire, a pattern that is associated with myasthenia gravis and warrants specialist assessment.
Symptoms of Ptosis
Symptoms vary depending on the severity and cause of the ptosis. In mild cases, drooping may be purely cosmetic; in more advanced cases, it significantly affects vision and daily function.
Causes & Risk Factors
Ptosis develops when the eyelid-lifting muscles weaken, loosen, or fail. Identifying the underlying cause is essential to determine whether surgical correction, medical management, or further investigation is required.
Aponeurotic Ptosis (Most Common)
Age-related stretching or thinning of the levator tendon is the most frequent cause in adults. The muscle remains functional but its attachment weakens, causing the lid to sit progressively lower.
Congenital Ptosis
Poor development of the levator muscle from birth results in a drooping upper eyelid present from infancy. Early assessment is essential to prevent amblyopia (lazy eye) in affected children.
Neurological Causes
Third nerve palsy, Horner syndrome, and myasthenia gravis can all cause ptosis through neurological disruption of eyelid muscle control. These conditions require prompt medical evaluation and investigation.
Mechanical Ptosis
A heavy eyelid due to excess skin, eyelid lumps or cysts, previous surgery, or prolonged contact lens wear, particularly hard lenses, can mechanically weigh down the lid and impair its elevation.
Trauma
Direct injury to the eyelid or surrounding structures can damage the levator muscle or its aponeurosis, resulting in acquired ptosis following blunt or penetrating trauma.
Post-Surgical Ptosis
Ptosis may develop following cataract surgery, glaucoma surgery, blepharoplasty, or a previous ptosis repair. Prolonged speculum use or local anaesthetic injection can temporarily or permanently affect the levator.
Diagnosis and Assessment
A thorough assessment determines whether ptosis correction is functional, cosmetic, or both, and guides the choice of surgical technique and extent of correction required.
Eyelid Height Measurements
Margin-to-reflex distance (MRD1) and levator function are measured precisely to quantify the degree of ptosis and determine the extent of lid elevation, guiding surgical planning.
Symmetry and Brow Evaluation
Brow position and eyelid symmetry are assessed alongside eyelid photography. Brow compensation, where the patient unconsciously raises the brow to lift the lid, is identified and factored into assessment.
Neurological Screening
A thorough clinical assessment excludes neurological causes, including third nerve palsy, Horner syndrome, and myasthenia gravis. Urgent investigation is arranged if a neurological cause is suspected.
Visual Impact Assessment
Visual field obstruction from the drooping lid is evaluated. In children, the impact on visual development is assessed to determine whether amblyopia is present or at risk of developing.
When to Seek Advice
Book an assessment if you notice any of the following:
- Increasing drooping of one or both eyelids
- Reduced vision caused by the eyelid covering part of the pupil
- Forehead strain or brow fatigue from compensatory brow lifting
- Difficulty reading, driving, or carrying out daily activities
- A child with a drooping eyelid, particularly if vision may be affected
- Sudden onset of a drooping eyelid, this requires urgent evaluation to exclude a neurological cause
“Early assessment prevents visual strain and, in children, long-term visual impairment. A sudden-onset drooping eyelid should always be assessed urgently to exclude a serious neurological cause.”
Meet the Team
Where to Find Us
Three convenient locations across West Yorkshire. Visit us for consultations, diagnostics, and treatments.
Bolton
136 – 140 Newport St
Bolton, Greater Manchester
BL3 6AB
Huddersfield
Woodlands, 4 Longbow Close
Huddersfield, HD2 1GQ
Book a Ptosis Assessment
If you or your child has a drooping eyelid affecting vision, appearance, or daily function, an early specialist assessment at The Eye Doctor Clinic will determine the cause and the most appropriate course of action.
