Droopy Eyelids (Ptosis) | Causes & treatment

What causes ptosis?

Ptosis can be present from birth (congenital ptosis) and is due to the muscle that lifts the upper eyelid not developing properly. In some cases, this can be an inherited condition, with other family members affected.

In children, if the low upper eyelid position is not corrected it can affect the development of vision and lead to amblyopia (lazy eye).

In adults, the most common reason that ptosis occurs is that over time the muscle that lifts the eyelid up becomes stretched and weakens.

It can also happen following cataract surgery, injury or contact lens use. Some neurological conditions e.g. Myasthenia Gravis can also cause ptosis but this is not common.

What are the symptoms of ptosis?

The primary and generally the first symptom of ptosis is drooping of the eyelid(s). Other symptoms can include a squint (eyes looking in different directions) and double vision.

Other secondary symptoms can be caused by the drooping of the eyelid. These include headaches caused by the eyebrow and forehead muscles being used, (even without the person realising that they are doing it) to try to lift the droopy eyelid up and improve the vision. This can trigger migraines and also lead to wrinkles in the forehead skin over time.

Other symptoms include back and/or neck pain caused by the ptosis sufferer adjusting the position of their head to see better, in cases of severe ptosis. Ptosis can also lead to dry eyes if it prevents the eyelid from functioning properly by keeping the eye moist. This in turn can cause excessive eye watering as the eye tries to correct the problem.

What types of ptosis are there?

Ptosis can be split into two main categories: congenital and acquired ptosis. Congenital ptosis is present from birth, and acquired ptosis becomes apparent at a later stage of life.

Congenital ptosis

Congenital ptosis is a result of the eye’s levator muscle failing to develop as it should. Children with ptosis may experience other visual defects – for example, a lazy eye. It’s generally recommended to treat congenital ptosis during childhood to preserve the child’s vision to as high a standard as possible. It is thought that congenital ptosis is hereditary.

Acquired ptosis

There are a number of reasons why an adult might develop ptosis. These are generally broken down into 5 categories:

• Aponeurotic: when the levator muscle becomes stretched and loses elasticity, often due to natural ageing. It can also be caused by too much rubbing of the eye over a long period of time
• Neurogenic: caused by an issue with the nerves controlling movement of the eyelid muscles. Causes can include third nerve palsy, Horner syndrome or myasthenia gravis
• Myogenic: caused by a weakening of the levator muscle as a result of a condition affecting the whole body, such as muscular dystrophy
• Mechanical: results from the eyelid being physically pulled down by extra skin or another abnormality
• Traumatic: caused by eyelid trauma which affects the functioning of the levator muscle

What are the risk factors for ptosis?

There are different risk factors for ptosis depending on the type of ptosis in question. Risk factors include:

• Age (older people are more likely to develop ptosis)
• Contact lens use (this can result in frequent eye rubbing, a possible cause of aponeurotic ptosis)
• Having eye surgery
• Having Botox (poorly-administered Botox can result in the substance migrating to an undesirable area of the eye and causing eyelid droop)

Ptosis Treatment Options

Ptosis is usually best corrected by surgery to restore the upper eyelid position.

Non-surgical options to treat ptosis and hold the eyelid higher include ptosis props that can be attached to glasses, Botulinum Toxin injections and using scleral contact lenses. Surgery usually results in a better aesthetic result than non- surgical options, but all available options will be discussed with you with your surgeon.

Celebrities with ptosis

Perhaps one of the most recognisable celebrities with ptosis is the actor Forest Whitaker. In his case he was born with the condition and it affects only his left eye.

Thom Yorke, the frontman of Radiohead, also has ptosis in his left eye. This was caused by surgery for a paralysed eyelid which went wrong.

The singer Gabrielle has ptosis in her right eye, which she often covers with either an eye patch or a sweeping fringe.