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Why does one or both of your upper eyelids droop – and what can you do about it?

Ptosis of the upper eyelids, also known as “blepharoptosis” describes the drooping of either one or both of the upper eyelids.
In this blog post, I explain what ptosis or drooping eyelid is and who you should see if you think your eyelid has ptosis.

What are the causes of ptosis?

There are several causes of ptosis including the drooping eyelid being present at birth (congenital ptosis), or more commonly acquired later on in life (involutional ptosis).
Congenital ptosis is due to the muscle that raises the eyelid, called the levator muscle, having an inherent abnormality in it. In congenital ptosis, your levator muscle has only a little bit of muscle in it and more fibrous and fatty tissue instead. Therefore the eyelid muscle cannot contract or relax normally.
An acquired involutional ptosis, in contrast, tends to appear with increasing age. With time, the tendon at the front of levator muscle, which is called the aponeurosis, becomes stretched, leading to the subsequent drooping eyelid. The tendon or aponeurosis is already very delicate and thin and can easily become stretched by age and also inflammations and swellings within the eyelid. Even contact lens wear can cause mild inflammation within the eyelid and lead to a mild upper eyelid aponeurotic ptosis.
There are also neurological causes of ptosis and as such can be an important sign that there is a problem with the nerve or a problem with the muscle such as myopathy or rarely myasthenia gravis. Mechanical causes of drooping upper eyelids include tumours or masses in or under the eyelid.

How do you know if you have ptosis, what are the symptoms?

It may be that you have only a small amount of ptosis, which you don’t like cosmetically. Ptosis really does not cause very many eye symptoms until it is quite advanced and the upper eyelid is impairing your vision.
If advanced, it can impair the upper visual field and means that you have a smaller overall binocular visual field. Therefore your symptoms, if any, would be worse on looking up or worse when you are tired, and the eyelids droop more. The reason ptosis is worse when you are tired is that the body does have compensatory mechanisms that come into play unconsciously when the upper eyelids droop.
The brain sends a message to the eyebrows and the forehead muscle, called the frontalis muscle, to help to lift the eyelids when there is smaller aponeurotic ptosis or even a large aponeurotic ptosis for that matter. Towards the end of the day the frontalis muscle lifting the eyebrows in the forehead gets tired, and therefore the eyelids droop and may well be noticed. This compensatory effect of elevating the eyebrows can itself lead to a headache or general ache across the brows.

Is my upper eyelid ptosis serious?

Usually, your upper eyelid ptosis is not serious. However, very rarely, it can indicate another problem. We already mentioned nerve diseases. There is an example, which is unilateral ptosis which can occur with a third nerve palsy, which could indicate a serious problem in the brain. It is also very important with any patient with ptosis that your oculoplastic surgeon looks underneath your eyelid as there could be a thickening or swelling there that might require further investigation such as a small biopsy. Sometimes the eyelid looks droopy because it has a growth underneath it.
Therefore, it is very important that (because they are myriad causes of ptosis) that if you have a drooping upper lid, your eyelid must be examined thoroughly by a specialist oculoplastic surgeon.

How do I find a specialist oculoplastic surgeon?

Well, I would like to say you should come to Clinica London, but this may not always be practical. However, at Clinica London, there is myself, Jane Olver, who is an oculoplastic surgeon.
The best way to find an oculoplastic surgeon is for you to look online at the British Oculoplastic Surgery Society (BOPSS) website if you live in the UK. If you live in the US, you may look up the American Academy of Ophthalmology or the American Society of Ophthalmic Plastic and Reconstructive Surgeons who will list oculoplastic surgeons.
Worldwide, it is important to find out whether your country has an oculoplastic surgery society because they will often put you in touch with the nearest oculoplastic surgeon to where you live.

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