Droopy Eyelids (Ptosis): The Basics

Let’s talk about droopy eyelids or ptosis. How often do you take time to observe the uniqueness in the physical characteristics of other human beings? Well, if you do, then you must have noticed certain things that set aside some human beings from others. One of such distinguishing features is a droopy eyelid. Technically, the sagging or drooping of the upper eyelid is known as ptosis. Ptosis or droopy eyelids is not a disease. It is only a symptom of another health condition that might necessitate treatment.

What causes drooping eyes?

• Sagging eyelids are generally caused by certain factors affecting the nerves, muscles, and skin of the eyelids.
• The oblique muscles, which permit the up and down movement of the eyelids, can grow weak as one advance in age. This can result in ptosis.
• One can also develop drooping eyelids at a tender age possibly because some people have weak eye muscles right from birth.
• Horner’s Syndrome can also cause ptosis. Nerve damage affecting the eyes and the face, Horner’s Syndrome is a common underlying cause of droopy eyelids. The syndrome itself is caused by lung cancer, injuries to the spinal cord or even stroke.
• One is also more exposed to the risk of droopy eyelids if the person has or has had a history of chronic health challenges such as myasthenia gravis and diabetes. The failure of the body system to properly digest sugar, as characteristic of diabetes, can lead to such complications as ptosis. With myasthenia gravis, the immune system attacks the tissues thereby influencing the interaction between nerves and muscles and subsequently resulting in drooping eyelids.
• Some patients might develop ptosis due to the recurrent events of headaches which strikes at cluster periods only to go into recess. This condition is called cluster headache.

Symptoms of ptosis or droopy eyelids

• The major and most significant physical sign that one has ptosis is the visible sagging of the upper eyelid(s). For some people, just one eyelid droops.
• Patients who have congenital droopy eyelids (i.e., they are born with the condition) often have uneven folds on the eyelids. In some cases, the folds are not there at all.
• People who have ptosis often tilt their heads up with raised brows when speaking with others. This is for them to see better and make eye contact with others. This is most common in children than in adults.

Diagnosing ptosis

Most times, it is very glaring that one has ptosis or droopy eyelids. So it might not need heavy diagnoses.

• Have a vision test done on both adults and children. An eye chart is used with the supervision of an ophthalmologist to ascertain if the sag affects vision.
• To diagnose if autoimmunity and diabetes underlie the condition, a blood test is necessary.
• An x-ray might also have to be performed to ascertain if there is any abnormality with the structure around the eye which might have caused the problem.

How to treat ptosis or droopy eyelids

There is a variety of options for the treatment of ptosis. The suitable option will be determined based on the underlying cause diagnosed.

• For droopy eyelids caused by diabetes, measures taken to manage diabetes should suffice to take care of the eyelid sag.
• If the drooping is conditioned by nerve damage, injuries to the spinal cord, cancer or tumors, the individual causative condition should be treated appropriately. The sag should disappear on its own, all things being equal.
• In the case of congenital drooping eyelids, surgery might be necessary since it usually does not correct by itself. The levator muscles do not always lift by themselves; hence, surgical repairs are mandatory. Note however that lifting and lowering the upper eyelids will be somewhat challenging immediately after the surgery. This will be rectified as the surgery heals and normal eyesight will be restored.
• You can decide to go for just an eyelid lift as a treatment option.
• Medications will be prescribed by the health care provider to treat myasthenia gravis if it is the underlying cause of ptosis. Such medications include pyridostigmine, neostigmine, immunosuppressant, prednisone, etc. and they cause the nerves and the muscles to work in unity.
• With drooping eyelids, there is a great possibility that a child could develop a lazy eye, otherwise known as amblyopia. This is a condition whereby vision is blurred or completely absent in one of the eyes. This is mostly caused by impairment in the nervous connection between the eye and the brain. This can be treated by a patch put over the normal eye to force the lazy eye to work better. If this does not work, you might need surgical repairs.

Droopy eyelids or ptosis in the long term

• A wide range of things is possible in the long term with the presence of ptosis. Such a possibility is conditioned by what caused the sagging eyelids in the first place.
• A surgical operation can correct the anomaly and restore good vision to the patient. It can also make for a good appearance or outlook. Such a difference can arise from just a little tucking in of the excess skin of the levator muscle on the upper eyelid. Depending on what is diagnosed, the levator muscle might need to be strengthened and reattached.
• Note however that there are cases where the eyelids do not return to the normal symmetrical looks after surgical operations.
• With surgery, there is the risk of developing an abnormal crease or fold on the eyelid, living with a bad scar, inability to completely close the eyelid and lack of symmetry. Therefore, surgery should only be done when the droop disables or severely hinders vision.

Tonika Bruce

Tonika Bruce, also known as The Network Nurse, is a multi-talented individual with a career spanning over 20 years. She’s a Registered Nurse, speaker, author, and advocate for change, excelling in business building and team development. Tonika holds two Master’s degrees in Nursing and Business Administration, (MSN & MBA) and is currently pursuing her Doctorate of Nursing Practice in Executive Leadership.

Her expertise extends to various fields such as nursing, entrepreneurship, business, basketball coaching, and executive leadership. She is a published author of “Relentless Pursuit: Proven Tips for Unlocking Your Potentials, Limitless Success and Post COVID Syndrome: A Guide to Repositioning the Nursing Profession for A Post COVID Era”. Currently, Tonika is working on Thrudemic, an anthology examining the impact of the coronavirus pandemic on medical professionals and patients.

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