Ptosis is a common eyelid disorder in which the upper eyelid droops partially or entirely over the eye, impairing vision and altering facial aesthetics. The severity of ptosis varies, ranging from mild cases with slight discomfort to severe forms that obscure the pupil and restrict the upper visual field.
Ptosis may be congenital (present at birth) or acquired later due to aging, eye surgeries, or trauma. Despite its impact on both function and appearance, ptosis is treatable through various methods that restore eyelid position and improve visual performance.
What is ptosis?
Ptosis is a condition where the upper eyelid droops below its normal position, covering part or all of the eye, which can impair or sometimes obscure vision. It is usually caused by weakness of the eyelid-lifting muscle or its nerve supply. It can affect one or both eyelids, and the severity difference between the two eyes can be significant. Some patients experience visual fatigue or an eyebrow headache from the constant effort to raise the eyelid, while others need to tilt their head back or raise their eyebrows to improve vision. The causes of ptosis vary from congenital to acquired and include aging, eye injuries, or muscle and nerve diseases.
Types of ptosis
Ptosis is divided into two main types depending on when it appears:
Congenital ptosis
It is noticeable at birth and is often caused by an abnormality in the development of the levator palpebrae muscle, which lifts the upper eyelid. It can affect one or both eyelids, and the condition is sometimes seen in more than one family member. In some rare cases, Marcus-Gunn jaw-winking ptosis, in which the eyelid spontaneously rises when the jaw is moved, is caused by an abnormal nerve connection. Early surgical intervention is recommended to correct this type of ptosis in children to avoid lazy eye.
Acquired ptosis
It appears later in life and is more common in adults. It is caused by a weakening or separation of the tendon that connects the levator muscle to the eyelid, often due to aging. It can also be caused by eye injuries, eye surgery (such as cataract surgery), or neuromuscular diseases such as myasthenia gravis or third cranial nerve palsy.
Causes of ptosis
The causes vary depending on its type and stage of onset:
- In children, the causes of ptosis are varied, including:
- A rare neurological disorder, such as Marcus-Gunn syndrome
- A congenital defect in the levator palpebrae superioris muscle
- Genetic factors in some families
- In adults, there are many causes of ptosis, the most important of which are:
- Prolonged use of rigid contact lenses may weaken the levator palpebrae superioris (the tendon that raises the eyelid)
- Muscular diseases such as myasthenia gravis or tonic muscular dystrophy
- Complications following eye surgeries, such as cataract or strabismus surgery
- Weakness or atrophy of muscles and tendons due to aging
- Injury to the oculomotor nerve (third cranial nerve)
- Injuries or tumors of the eyelid or orbit
In some rare cases, ptosis may be caused by neurological syndromes such as Horner’s syndrome or a partial stroke affecting the ocular nerves.
Symptoms of ptosis
The symptoms range from mild to severe, depending on the amount of eyelid drop:
- In adults, ptosis can cause a decrease in peripheral vision and difficulty performing daily tasks such as reading or driving, in addition to its aesthetic impact
- In children, tilting the head back or lifting the chin may be seen to improve vision, and lazy eye may develop if not treated early
- Visual fatigue and forehead muscle fatigue due to trying to lift the eyelid constantly
- A visible drop in the upper eyelid that may cover part of the eye or the entire pupil
- Difficulty opening or keeping the eye open while reading or driving
- Increased tearing or dry eye as a result of the eyelid movement disorder
- Headache or eyebrow pain due to constant muscle contraction
Ptosis in children
Ptosis in children is often a congenital condition, meaning that the child is born with it due to a weak or underdeveloped levator muscle of the upper eyelid. Ptosis can affect one or both eyelids and varies in severity. In mild cases, it may not affect vision, but in severe cases, the eyelid can block the upper visual field, leading to lazy eye due to reduced visual stimulation.
Parents sometimes notice their child lifting their chin or opening their mouth while looking to see clearly, which are signs that an urgent medical evaluation is needed. Treatment depends on the degree of ptosis and the risk of vision impairment. It may include regular monitoring or early corrective surgery to strengthen the levator muscle or to suspend the eyelid on the forehead muscles. Early intervention protects normal vision development and improves the appearance of the eyes.
Diagnosis of ptosis
Ptosis is usually diagnosed clinically by observing the appearance of the lowered eyelid, as the doctor can determine the condition by simply examining the eyes. If it affects both eyelids, the assessment may be more subtle and require a specialized examination. The doctor begins by taking a history to determine when the symptoms started, then performs a clinical examination to assess eyelid height, levator muscle strength, and eye movement. The patient is often referred to an ophthalmologist for a comprehensive evaluation that includes:
- Slit lamp examination: To evaluate the eyelid, cornea, and conjunctiva for any swelling or mass.
- Visual field test: To see how much vision is affected by eyelid drop.
- Eye movement test: To determine the presence of any accompanying nerve paralysis or muscle weakness.
- Tensilon test: In suspected cases of myasthenia gravis.
In children, the doctor may notice ptosis from birth or after parents complain of a head tilt back or lowered eyelid. Sometimes the child is referred to a neurologist for a nerve and muscle evaluation to make sure there are no associated neurological issues.
Eyelid ptosis treatment
Treatment depends on the severity of the condition and the cause. If the ptosis is mild and does not affect vision or overall appearance, the patient may not need any treatment, and the doctor will simply monitor the patient periodically. However, if it impairs vision or creates an obvious cosmetic issue, therapeutic intervention is recommended.
Non-surgical treatment for ptosis
It is used in mild or temporary cases or in patients who are unable to undergo surgery, including:
- In children, an ophthalmic bandage can be used on the healthy eye to stimulate the weaker eye in case of ocular laziness
- Using an eyelid support, a device that attaches to glasses to lift the eyelid mechanically
- Treating the underlying cause, such as treating myasthenia gravis or neurological disorders
Surgical treatment for ptosis
Before surgery
The doctor performs a thorough examination to determine the type of ptosis and assess the function of the levator palpebrae muscle. Vision and visual field tests are also performed to assess the impact of ptosis on vision, and the results are discussed with the patient to determine the most appropriate surgical approach. The patient may be asked to stop blood-thinning medications such as aspirin or warfarin before surgery, after consulting with the specialist, to minimize the risk of bleeding. The patient is informed about what to expect regarding the appearance of the scar, the recovery time, and the necessary post-operative care.
During surgery
Surgery is usually performed under local anesthesia with sedation, allowing the surgeon to adjust the height of the eyelid during surgery precisely. The surgeon makes a small incision in the natural crease of the upper eyelid to access the levator muscle, which is then tightened or shortened with fine sutures to elevate the eyelid to the desired level. In some cases, the procedure is performed from within the eyelid without an external incision, especially when a minor correction is needed. Absorbable sutures are used to close the wound, and the procedure usually takes 45 to 60 minutes per eye.
After surgery
After surgery, a compression bandage is applied to the eye for about a day to minimize swelling and bruising, and cold compresses are used for the first few days. Antibiotic ointment on the sutures and moisturizing eye drops are recommended to prevent dryness due to the difficulty in temporarily closing the eyelid. The patient can shower as usual with gentle drying of the eyelid, and the stitches are often removed or dissolve spontaneously within a week. For the first 10 to 14 days, it is advisable to avoid rubbing your eyes or engaging in strenuous activities. Results will gradually improve over the weeks and are considered permanent in most cases.
Possible complications of ptosis surgery
Although the surgery is generally safe, there are some risks, such as:
- Over- or under-correction (disproportionate elevation or depression of the eyelid)
- A slight asymmetry in the shape of the eyelids may need to be adjusted later
- Dry eye due to the difficulty in temporarily closing the eyelid completely
- Mild bleeding or inflammation at the wound site
- Temporary eyelid swelling or bruising
Treatment results and follow-up after ptosis surgery
Most cases show significant improvement in vision and appearance after the procedure, and the eye’s normal shape is restored within a few weeks. You should follow up with your doctor regularly after surgery to ensure that the wound has healed and the eyelid height has stabilized. In cases where neurological or muscular diseases cause ptosis, the patient is followed up by a collaborative effort between the ophthalmologist and neurologist to manage the underlying cause and ensure the issue does not recur.
When should I see a doctor?
It is important to see a doctor immediately if you experience sudden or rapidly worsening ptosis, especially if you also have double vision or pain in the eye or head. These symptoms could indicate a serious neurological issue, such as third nerve palsy or a stroke. Additionally, any child exhibiting a drooping eyelid or tilting their head back while looking should be examined promptly, as delaying treatment could result in permanent vision problems or lazy eye development.
In adults, it is advisable to consult an ophthalmologist if you notice difficulty opening your eyes, recurrent visual fatigue, or a change in the appearance of the eyelid after surgery or injury. Early detection helps the doctor identify the underlying cause and develop an effective treatment plan before vision deterioration or eye deformity occurs.
Prevention and minimizing the risk of acquired ptosis
Although some cases of acquired ptosis cannot be prevented entirely, a healthy lifestyle and eye care can minimize the risk of it occurring or progressing. Avoid vigorously or repeatedly rubbing your eyes, as this can weaken the tiny muscles that lift the eyelid. It’s also best to minimize prolonged use of rigid contact lenses, as prolonged use can, over time, cause the tendons supporting the eyelids to sag.
It is also essential to see your doctor regularly for early detection of neurological or muscular conditions that may cause ptosis, and to follow post-operative instructions to avoid pulling the eyelid or overworking the muscle. Adequate sleep and good nutrition rich in nerve vitamins (such as B12 and E) will help support the health of the muscles and nerves that move the eyelids and maintain a natural eye appearance for as long as possible.
In conclusion, ptosis is a condition that impacts both visual function and facial aesthetics, but with early diagnosis and appropriate treatment, whether surgical or non-surgical, patients can achieve excellent outcomes and long-term stability. At Bimaristan Medical Center, we provide access to advanced correction techniques in Turkey, performed by top-tier ophthalmologists and plastic surgeons to deliver optimal results.
Sources:
- American Academy of Ophthalmology. (n.d.). What is ptosis (droopy eyelid)? Retrieved October 29, 2025,
- Moorfields Eye Hospital NHS Foundation Trust. (n.d.). Ptosis: Diagnosis and treatment. Retrieved October 29, 2025,
- University Hospitals Sussex NHS Foundation Trust. (2025, October 6). Ptosis (drooping eyelid).
