What is ptosis?

Pathologic droopy eyelid, also called ptosis, may occur due to trauma, age, or various medical disorders.
This condition is called unilateral ptosis when it affects one eye and bilateral ptosis when it affects both eyes. It may come and go or it might be permanent. It can be present at birth, where it’s known as congenital ptosis, or you can develop it later in life, which is known as acquired ptosis.
Depending on the severity of the condition, droopy upper eyelids can block or greatly reduce vision depending on how much it obstructs the pupil. In most cases, the condition will resolve, either naturally or through medical intervention.

Damaged nerves

Nerve damage from an eyelid injury or from conditions that affect the brain and the nervous system can also cause your eyelids to droop.
Horner syndrome is one such condition. It’s a rare syndrome that happens when something (a stroke or a tumor, for example) damages the nerve that controls one of the muscles connected to eyelid movement. Generally, Horner syndrome also causes your pupils to get very small and the involved part of your face to stop sweating. Ptosis associated with Horner syndrome usually goes away when the underlying problem is treated.
Nerve damage from long-term uncontrolled diabetes and high blood pressure can also lead to ptosis, which is why it’s so important to get diagnosed and treated for each condition.

Muscle problems

Eyelid movement is controlled primarily by three muscles, the most important of which is the levator muscle. Anything that affects these muscles can also affect how your eyelid works.
One such droopy eyelid cause is an inherited muscle disease called oculopharyngeal muscular dystrophy (OPMD), a type of muscular dystrophy, which affects not only eye motion but also swallowing and even some limb muscles. Another is chronic progressive external ophthalmoplegia (CPEO), which usually causes ptosis in both eyes. Myotonic dystrophy, the most common form of muscular dystrophy that starts in adulthood, also causes ptosis in both eyes.

You’re getting older

We hate to say it, but drooping eyelids are yet another inevitable consequence of aging. It’s called aponeurotic or senile ptosis.
“Gravity and time just move everything downward, and sometimes it gets to the point the eyelid itself is drooping,” says Dr. Rizzuto. “Sometimes excess skin on the eyelid can hang over the eyelid and block vision.”
In most cases, the problem is cosmetic, and elective surgery can restore at least some of your eyelids’ youthful vigor if you choose. At times, the drooping lid can affect your sight, in which case you may need surgery to maintain vision.

Surgery

Doctors have become so practiced at performing different types of eye surgery that complications don’t happen often. But they can happen. And if the complication is a droopy eyelid, it’s called post-surgical ptosis.
“The levator muscle of the eye can separate over time after cataract surgery,” says Jessica Zwerling, MD, director of Montefiore Einstein’s Center for the Aging Brain and associate professor of neurology at Albert Einstein College of Medicine in New York City.
Ptosis has been reported after cataract, corneal, refractive (like Lasik), and glaucoma surgery. Experts aren’t sure exactly why this is, though the types of instruments and anesthesia used by the surgeons may play a role.

Cancer

Although tumors inside your eye aren’t going to affect the eyelid, cancer around or outside the eye can affect the muscles that raise and lower your eyelids. This includes tumors anywhere along the nerves or along the arteries that supply the eye, or in the muscles controlling your eye. Ptosis can also–rarely–be a symptom of metastatic cancer, like breast cancer or lung cancer.
Contact an ophthalmologist whenever you notice something wrong with your eyelids, especially if it develops quickly over a few days or hours and is accompanied by other symptoms like weakness in your arms, legs, or face; a serious headache; or double vision.