Overview
The upper lid is held open by a small muscle and its tendon. When either weakens or detaches, the lid drops. Most cases are age-related and gradual; in children, congenital ptosis matters because a lid covering the pupil can cause a lazy eye.
The reason ptosis is worth having examined rather than simply tolerated is that a small number of cases signal a neurological or muscular condition, and the pattern of onset is what distinguishes them.
What are the common symptoms?
- One or both upper lids sitting lower than usual
- A reduced upper field of vision; tipping the head back to see
- Raising the eyebrows constantly, and brow ache from doing so
- Tired-looking or asymmetric eyes
- In children, a head tilt or chin lift
What causes it, and who is at risk?
- Age-related stretching of the levator tendon — the commonest cause
- Long-term contact lens wear or previous eye surgery
- Congenital, present from birth
- Nerve problems, including third nerve palsy and Horner's syndrome
- Myasthenia gravis, where the droop worsens through the day
- Trauma, or a mass in the lid
How is it treated?
Treatment depends entirely on the cause, which is why the assessment matters more than the droop itself.
- Measurement and photography to document the degree and any change
- Visual field testing, which is often what determines whether surgery is funded
- Surgical tightening or reattachment of the levator muscle
- Prompt treatment in children to prevent amblyopia
- Treating the underlying condition where one is found
When to get seen quickly
A droopy lid that appears suddenly, especially with double vision, a different-sized pupil, headache or facial weakness, is a medical emergency. Go to an emergency department.
This page is general information, not a diagnosis. Only an eye care professional who has examined you can tell you what is actually going on.