Ptosis: Everything you need to know about eyelid drooping

As you age, it is not uncommon for your eyelids to sag or droop downwards. Besides the visible drooping, you may also feel pain around your eyes and your face may look tired.

Ptosis or blepharoptosis is the term for drooping of the upper eyelid that can happen in one or both the eyes. Depending upon how much the eyelids droop, your vision can either get reduced or completely blocked.

Although it can be triggered at any age, older adults are more susceptible to this condition due to the normal effects of ageing.

Eyelid ptosis can be completely genetic or you may develop it later in your life due to an eye injury or disease.

Ptosis can be present at birth due to a congenital abnormality known as congenital ptosis and when it occurs later in life, it’s called acquired ptosis.

In most cases, ptosis is resolved on its own while some may need medical intervention.

Ptosis symptoms

The main symptom that you will come across is the sagging of one eyelid (unilateral ptosis) or both the upper eyelids (bilateral ptosis). This situation lead to other symptoms such as:

• Vision loss
• Watery eyes
• Dry eyes
• Eye Pain
• Headache

When you are presented with these symptoms, make a visit to your optometrist or eye doctor to know what’s causing the trouble. If you get regular eye tests done, your optometrist might detect this condition early on. The NHS recommends an eye check-up every two years, and every year in case of the elderly and children or if you’re facing any trouble.

If you experience a vision problem due to ptosis of the eye, you may have to tilt your head back to see clearly from the affected eye. Or you have to raise your eyebrow a little higher to lift your droopy eyelid.

While some people may not even notice the ptosis eyelid, others might complain of pain around the eyes and a tired look on their face.

In case your ptosis is severe, your optician might ask you to see an eye doctor to make sure that your droopy eyelid hasn’t resulted from an underlying medical condition.

Who is at risk of ptosis?

There are some medical conditions that put you at a greater risk of developing eye health problems such as floppy eyelids.

Underlying disorders such as blepharitis or meibomianitis that mainly target your eyelids may result in ptosis. Routine cataract surgeries are to be blamed for post-surgical eyelid ptosis as a result of iris stretching and inflammation of the eyelid.

The process of sagging eyes starts somewhere around your mid 40s as a consequence of weakening of the eye muscles that hold the eyelids upwards. This is why adults over the age of 40 must get regular eye test to detect the most common age-related eye problems.

What leads to ptosis?

Ptosis of the eye can be attributed to the issues with the ‘levators’ (muscles responsible for lifting up the eyelids). In some cases, this condition may arise temporarily due to a bacterial infection such as stye.

Congenital ptosis that is present from birth may have genetic reasons behind it. Children with ptosis may have to deal with impaired vision and ‘lazy eye’ where the vision won’t develop completely. However, kids won’t show the eyelid droop as the levators muscles are not developed completely.

In young individuals, the damage to the eyelids may occur due to:

• Excessive rubbing
• Eye injury
• Use of rigid gas-permeable contact lens
• Eye surgery

Coming to the more severe causes , it may also crop up due to neurological issues or cancer of the optic nerves or muscles.

Ptosis treatment

Treatment for ptosis eyelid depends on the severity of the condition and also the patient’s preferences. It generally involves a surgery wherein the levator muscles are tightened and the extra fat or skin in the eyelid is removed.

If it has stemmed from the natural process of ageing or it was present during birth, it’s not at all harmful to your health. In such cases, your doctor may advise you to not undergo the surgery.

If an underlying medical condition is found to be the culprit behind your sagging eyelid, you will likely be treated for that. It will prevent your eyelids from drooping further.

In the event of a visual block due to excessive drooping, you will need ptosis surgery. Or you will have to wear special glasses (ptosis crutch) that can hold up the eyelids. This option is preferred if your condition is only temporary or you don’t pass for a surgery.

What to expect after ptosis surgery?

If you have undergone a surgery for eyelid ptosis, your eyelids might not be symmetrical even when they are slightly higher than they were before. In some rare cases, the patient may also lose the usual eyelid movements.

Make sure you choose a surgeon who is experienced at performing these kinds of surgeries. When done wrong, your eyelids will not close properly and you may even develop dry eyes.

Preventing ptosis eyelid

It’s quite hard to prevent the development of eye drooping especially if it is congenital or acquired by an irreparable cause.

If your eyelid muscles have become less efficient due to ageing, the situation is somewhat unpreventable. However, if the eye ptosis has resulted from wearing rigid contact lenses or endless eye rubbing, you can stop the development of eyelid drooping. You can switch to glasses that are super comfortable and super fashionable means of correcting eyesight problems. Some people opt for hard contact lenses to wear them with sunglasses. But you can always go for prescription sunglasses, or even transition lenses - which develop a dark tint as you step out.

There are also some eyelid exercises that will lift them naturally. All you have to do is just put a gentle pressure on your eyelids and hold them upwards.

When to seek help?

Droopy eyelid is not an alarming situation. But, if you experience the following, don’t hesitate to seek immediate medical help:

• If your sagging eye is followed by the signs of stroke such as blurry vision, headache, trouble talking and weakness of the facial muscles or arms & legs.
• A sudden drooping of the eyelid or if the condition grows too fast.
• A droopy eye accompanied by eye redness, fever and rigid eye movements.

It is important for patients to see if their child’s eyes look uneven. You can take the benefit of NHS eye test and detect this problem while it can be treated.

Eyelid ptosis may also change the way light is focused on your eyes. This can lead to astigmatism over time and you will need prescription glasses to see clearly.

The takeaway

Eyelid drooping is completely normal and harmless to your health. However, if it causes visual obstruction, consider having a surgery and avoid driving until the problem is treated completely. It is best if you spot this problem while it is still new.