Ptosis (Drooping Eyelid)

Overview

Ptosis is the medical term for a drooping upper eyelid. When an eyelid droops, the edge of the lid sits lower than normal and can partly or fully cover the pupil. Ptosis may affect one eye or both, and it can range from a slight, mainly cosmetic droop to a severe one that blocks vision. People with significant ptosis often raise their eyebrows or tip their head back to see beneath the drooping lid.

Ptosis is frequently a natural part of aging, as the muscle that lifts the eyelid stretches and weakens. But it can also result from problems with the nerves or muscles that control the eyelid, or from injury, and a sudden onset can occasionally point to a serious condition. How quickly the ptosis appeared, whether it changes during the day, and what other symptoms accompany it all help determine the cause and urgency. A droop that has slowly developed over years usually means something very different from one that appears within hours or days, so timing is one of the first things a doctor will ask about.

Common Causes

Ptosis can have several underlying causes:

• Aging (involutional ptosis): The most common type, as the eyelid-lifting muscle stretches over time.
• Congenital ptosis: Present from birth due to an underdeveloped eyelid muscle.
• Muscle disorders: Myasthenia gravis causes weakness that typically worsens with use.
• Nerve problems: Horner syndrome and third nerve problems can cause ptosis with pupil changes.
• Stroke: A stroke may cause sudden ptosis with other neurological signs.
• Eyelid injury or surgery: Damage to the lid or its muscle.
• Eyelid growths or swelling: Weighing the lid down.

Associated Symptoms

The symptoms that occur with ptosis help point to its cause:

• Reduced or blocked vision from the upper field
• Double or blurred vision
• A difference in pupil size between the eyes
• Drooping that worsens through the day or with fatigue (suggesting myasthenia gravis)
• Facial weakness, slurred speech, or limb weakness (suggesting stroke)
• Severe headache or eye pain
• Eyebrow raising or head tilting to compensate

Sudden ptosis with double vision, a severe headache, an unequal pupil, or weakness is a warning sign that requires urgent evaluation.

Diagnosis & Evaluation

A doctor diagnoses the cause of ptosis through examination and selected tests:

• Eyelid measurements: Assessing the degree of droop and how well the eyelid muscle works.
• Eye examination: Checking eye movement, pupils, and vision.
• Neurological assessment: Looking for signs of a nerve or brain cause.
• Targeted tests: Blood tests or other studies for myasthenia gravis, and imaging (CT or MRI) if a nerve problem, aneurysm, or stroke is suspected.

Whether the ptosis came on suddenly or gradually, and whether the pupils differ, are especially important in deciding how urgently to investigate.

Treatment & Management

Treatment depends on the cause and on whether vision is affected:

• Age-related ptosis: Surgery to tighten or reposition the eyelid muscle when the droop blocks vision or for appearance.
• Myasthenia gravis: Medications to improve muscle strength; see myasthenia gravis.
• Nerve-related ptosis: Treating the underlying nerve condition.
• Stroke: Urgent stroke care; see stroke.
• Congenital ptosis: Monitoring and sometimes surgery to protect a child's developing vision.
• Growths or injury: Removing the growth or repairing the eyelid.

Surgery can effectively correct persistent ptosis, but identifying and treating any underlying medical cause comes first.

Self-Care & Prevention

• Protect your eyes from injury
• Manage conditions like diabetes and high blood pressure that affect nerves and blood vessels
• Report new or sudden eyelid drooping to a doctor
• Have a child's eyelid drooping evaluated to protect their vision
• Seek care for drooping that worsens with fatigue or use

When to See a Doctor

Call emergency services immediately if ptosis appears suddenly with:

• Facial drooping, arm weakness, or slurred speech (stroke signs)
• Sudden double vision or a severe headache
• An unequal pupil with eye pain
• Confusion or difficulty moving

See a doctor promptly for ptosis that worsens through the day, blocks part of your vision, or comes with double vision. Gradual, age-related ptosis can be evaluated routinely, especially once it begins to interfere with sight.

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. Ptosis and myasthenia gravis — Symptoms and causes.
2. American Academy of Ophthalmology. Ptosis (Drooping Eyelid).
3. National Institute of Neurological Disorders and Stroke (NINDS). Myasthenia Gravis information.
4. MedlinePlus, U.S. National Library of Medicine. Eyelid drooping.