Ptosis in Adults

What is ptosis?

Ptosis is drooping of the upper eyelid. The lid may droop slightly or it may cover the pupil and block vision. (The pupil is the dark center of the eye.) It may happen to one or both eyelids.

How does it occur?

The most common cause of ptosis in adults is a loosening of the connection between the muscle that lifts the eyelid and the eyelid. This problem is called levator dehiscence. (Levator is the name of the muscle that lifts the eyelid.) It usually happens gradually. Some eye surgeries or injuries around the eye can cause or worsen the loosening.

Damage to the nerve that sends messages to the levator muscle is another possible cause. Sometimes the problem is with the connection between the nerve and the muscle or with a weakening of the muscle.

Rarely, damage to the nerve that sends messages to another muscle in the eyelid (Mueller's muscle) can also cause drooping of the eyelid. This is called Horner's syndrome. In Horner's syndrome, the pupil on the side with the droopy eyelid is smaller than the other pupil. Your healthcare provider will use eyedrops to diagnose this condition.

What are the symptoms?

The drooping eyelid is the main symptom of ptosis. You may find that you are tilting your head back or raising your eyebrows to lift the eyelid. You may notice a loss of vision, especially in the upper part of your field of vision. Or you may simply have a vague, tired feeling about your vision. Some people get headaches or aches in their eyebrows from constantly trying to lift their eyelids.

If you have both a droopy eyelid along with an enlarged pupil and an eye that is turned down (called hypotropia) and out (called exotropia), you should see a healthcare provider right away. These symptoms could be caused by a life-threatening condition.

How is it diagnosed?

Your healthcare provider will examine you. Your provider will determine the reason for your droopy eyelid and make sure that you do not have a more serious underlying problem. You may have a test of your field of vision to see how much the droopy eyelid is hurting your vision. During this test, the technician will examine your peripheral vision with your droopy eyelids. Then your eyelids will be taped up to see how your vision would improve if your eyelids were surgically lifted.

How is it treated?

If ptosis is the result of muscle or nerve disease, the disease is treated first. If a loosening of the connection between the muscle and the eyelid is the problem, surgery to tighten the connection or simply shorten part of the eyelid can be done.

How long will the effects last?

How long the drooping lasts depends on the cause. For example, if the droopy eyelid was caused by previous eye surgery or an injury, it may get better on its own without treatment. When loosening of the connection between the muscle and the eyelid is the problem, surgery is the only way to fix the problem.