Patients report to us that they have this issue of drooping eyelids should they be concerned or is it a cosmetic issue? That depends on the degree of the ptosis, the time it has been present, and if the patient is a child or an adult.
In mild cases the issue is only with appearance, but in more serious or long term cases there is a reduction in field of vision, eye strain which in turn causes issues, also in children this may result in amblyopia and in extreme cases of going untreated may cause permanent visual loss.
What Is Ptosis?
Ptosis is a term used for the drooping of the upper eyelid. It may involve one eye or both and may be mild (only a 1-2 mm drop) or in a serious case the lid may cover the pupil.
Ptosis is present at birth in some and develops later in others. In many adults it is a result of the stretching or weakening of the eyelid lifting muscle and its tendon, in children it is very often a result of a birth defect in that muscle.
Ptosis Causes: Why Does the Eyelid Droop?
We divide ptosis causes into broad groups:
- Aponeurotic (age‑related)
In adults what we see most often is that the levator muscle (which raises the lid) or its tendon has either stretched or come detached which is usually a result of aging, long term use of contact lenses, or past eye surgery. - Congenital (since birth)
At birth the levator muscle does not develop properly which ptosis causes a droopy lid. Also some of these kids may have abnormal head postures or reduced range of motion in the lid when looking up.
- Neurogenic
Nerve issues (for example, third nerve palsy or Horner syndrome) which in turn may weaken the signals that usually lift the eyelid. - Myogenic (muscle disease)
Conditions which present as myasthenia gravis or muscular dystrophies may affect the muscles which move the eyes. - Mechanical or traumatic
Eyelid tumors, scar tissue, or great degree of swelling may cause the lid to drop; also direct injury may damage the structures which lift it.
For that which is the case, any new or acute onset of ptosis also if it is accompanied by double vision, limb weakness seems to cut out there should be evaluated right away at an eye specialist hospital.
Is Ptosis Harmful for the Eyes?
In adults
In adults ptosis is a more functional and cosmetic issue as opposed to a direct eye issue, while at the same time it does bring up problems.
- Should the lid cover the upper part of the pupil which in turn may reduce your field of view, improve the difficulty of drive, read, and with which also may make your walking confidence low.
- Also a great number of people put on their eyebrows’ movement or will tip head back in an attempt to see better but in doing so may present with a fore head pain, neck strain and fatigue by the end of the day.
- Also many of these patients will present to have a “sleepy” or “unwell” look and because of that which may affect social and work confidence.
In children
In children serious cases of ptosis are the rule.
- When the lid covers the pupil the brain does not receive a clear image out of that eye and so amblyopia (lazy eye) develops.
- Also in ptosis we see higher rates of refractive errors (in particular astigmatism) and strabismus which in turn increases the risk of amblyopia.
- Also they may adopt a chin up posture to see under the lid which in the long term affects comfort and posture.
Thus while mild ptosis may be monitored, for moderate to severe ptosis in a child early assessment is almost always required and usually surgery is the correction of choice to protect vision.
How We Evaluate Ptosis in Clinic
During my time with you we do more than just “look at the lid”. We do a full ptosis evaluation which includes:
- Measuring the extent of lid drop and function of the levator muscle.
- We do eye movement assessment, look at the pupils’ response, and check alignment which in turn rules out nerve or muscle related disease.
- Also we look for related issues refractive error, strabismus or amblyopia which are very much present in kids.
- We review your health history, what medications you are on, use of contact lenses, also we note any past injury or prior eye treatments.
In some patients, especially those with co-existing glaucoma or other internal eye conditions, we may perform visual field testing and angle assessment using a gonioscopy lens as part of a comprehensive eye examination at our eye hospital.
A gonioscopy lens allows the ophthalmologist to examine the drainage angle of the eye in detail and identify conditions that may require additional management alongside ptosis treatment.
Treatment Options: Not all ptosis patients require surgery.
- Observation
Very slight ptosis which does not impair vision and is not a problem for the patient may be put on a watch and wait course of action. - Glasses with a ptosis prop
For those that are not candidates for surgery a small plastic “device” may be attached to glasses which in turn raises the lid. This is not a cure for ptosis but does what it can to keep the eye lid out of the visual field. - Treat underlying disease
In the case of neurogenic or myogenic ptosis it is of great importance to treat the base cause which may be a nerve or a muscle issue (for example myasthenia gravis) which at times will see improvement in lid position.
When ptosis does in fact impair vision, ptosis causes symptoms in the patient, or in the case of children presents a risk of amblyopia we turn to surgical intervention which is usually the best long term solution.
Ptosis Surgery: What It Does.
Ptosis surgery is for the purpose of raising the eyelid which we do by strengthening or going around the weak muscle as per the type and degree of ptosis.
Common methods of which we use are:
- Levator advancement (external approach)
An incision in the eyelid crease is performed, the levator tendon is identified and tightened which also includes the lid raised to the right position. - Internal (posterior) approach / Müller’s muscle surgery
The eyelid is rolled inside out and the muscles which lift it from the inside are shortened, this is for mild ptosis in which the muscle strength is still good. - Frontalis sling
In the case of severe ptosis with very poor muscle function which is often a congenital issue we see the lid attached to the forehead muscle via a sling which in turn is raised by the eyebrows.
These are usually day case procedures which for adults we do with local anesthetic and for young children we use general anesthetic. The method of treatment is chosen by your ophthalmologist based on the levator strength, the cause of the ptosis and if it is in one or both of the eyes.
Risks and Recovery After Ptosis Surgery
In like fashion any operation goes in for risks, but serious ones are at a minimum with experience of the oculoplastic surgeon.
Possible issues include:
- Over and also under correction (lid too high or still too low).
- Transient issue with full eye closure which in turn may cause dryness.
- Dry eye issues or irritation because a greater area of the eye is exposed.
- Asymmetry between the two lids which at times requires readjustment or a second operation.
- Also very rare is infection or bleeding.
Most patients go home the same day, use lubricating drops and ointment for a few weeks’ and return to light activities soon. Swelling and bruising which usually takes 1-2 weeks to go down, and the final lid position is determined once healing is complete.
How to Treat Ptosis Naturally?
This is what I get asked the most. For true ptosis which is a result of a weak or slipped muscle we don’t have it out that natural exercise or home remedy which will revert it back to normal.
What you can do is:
- Keep the eye’s surface free of dryness which may be treated with lubricating drops.
- Also make sure that your glasses’ prescription is up to date and that you are treated for any other eye issues.
- In some cases we may recommend a ptosis prop which is attached to your spectacles if surgery isn’t an option.
But if ptosis is moderate or severe which is very much the case in a child waiting for it to improve on its own is not a solution as it may cause vision problems; in these situations the best and only really permanent correction is usually to have surgery.
What Are the Disadvantages of Ptosis?
The main disadvantages of ptosis include:
- Reduced field of view and performance in tasks which include driving, reading, or climbing stairs.
- Eye strain, forehead ache, and tiredness from the effort to open the eye.
- In children we see a greater risk of amblyopia, refractive error, and strabismus if the visual axis is blocked.
- Cosmetic and psychological patients report to look sleepy, sad, or older than they are.
This is what we do not put off ptosis as “just cosmetic” issue, especially when it interferes with function or growth of visual function in a child.
Can I Fix Ptosis Without Surgery?
For mild cases that do not affect vision, non‑surgical measures like ptosis props on glasses or simply monitoring may be enough. However, these support the lid—they do not repair the weak muscle.
At present, ptosis surgery is the only reliable way to permanently tighten or bypass the eyelid lifting muscle. For children at risk of amblyopia and adults whose vision is compromised, surgery is usually strongly recommended.
Eye Care at Vasan Eye Care
At Vasan Eye Care we have an oculoplastic trained eye specialist evaluate cases of ptosis. We look at the cause, the severity, muscle strength, and visual impact of the condition before we suggest any eye treatment. When necessary, our evaluation may also include specialized diagnostic tools such as a gonioscopy lens to assess eye health and rule out associated conditions like glaucoma. For some patients watchful waiting is appropriate; for others we recommend timely ptosis surgery at our dedicated eye hospital which is the best way to protect their sight and appearance.
Frequently Asked Questions
There is little proof that exercises or at home treatments reverse natural course of true ptosis due to muscle weakness or tendon issues. We do have that lubricants, good lighting, and glasses will help with your comfort but they will not raise the eyelid up which is the issue in ptosis.
As for what can go wrong with ptosis you may have a narrowed field of vision, experience eye strain and headaches, also you may appear tired or unwell. Also in kids it can cause amblyopia, changes in refraction and strabismus if the eyelid covers the pupil.
Mild ptosis that does not affect vision may be managed with observation or a ptosis prop attached to glasses. But if the lid is clearly drooping into the visual axis or causing symptoms, surgery is currently the only effective way to correct the position.
Reference Links
- PubMed – Ptosis: Causes, Presentation, and Management
https://pubmed.ncbi.nlm.nih.gov/12925861/ - NYU Langone – Ptosis Surgery
https://nyulangone.org/conditions/ptosis/treatments/ptosis-surgery - Healthdirect – Ptosis Surgery (Adult)
https://www.healthdirect.gov.au/surgery/ptosis-surgery