This week Dr. Raymond Douglas discusses what causes droopy eyelids and how to fix them.
What is Ptosis?
Ptosis is the medical term for droopy eyelids. It’s the sagging or downward displacement of the upper eyelid, which can happen in one or both eyes. It can be barely noticeable or bad enough to affect your vision. Besides vision, ptosis can also change the shape of your face, making you look tired, older or less alert.
Types of Droopy Eyelids
There are different types of droopy eyelids, each with its own cause:
- Congenital Ptosis: Born with it and usually due to underdeveloped eyelid muscles.
- Age-Related Ptosis: As we age, the muscles that lift the eyelid can stretch or weaken.
- Neurogenic or Traumatic Ptosis: Caused by nerve damage, neurological conditions or trauma.
How It Affects Daily Life
For many people, droopy eyelids are more than just a cosmetic issue. In moderate to severe cases, sagging lids can block your vision, making daily tasks like reading or driving hard. Even mild ptosis can affect your self-esteem especially especially if it makes the eyes appear tired or sad.
Causes of Droopy Eyelids
- Age-Related Ptosis (Most Common): Over time, the levator muscle (the muscle that lifts the eyelid) can weaken or separate, causing the lid to droop.
- Genetics: Congenital ptosis can run in the family and often presents in childhood.
- Medical Conditions: Conditions like Horner’s syndrome, Myasthenia Gravis or third cranial nerve palsy can damage the nerves or muscles that control eyelid movement.
- Injury or Surgery: Trauma or complications from surgery can cause droopy eyelids.
If Your Eyelashes Are Low
This often results in eyelids that can be asymmetric or one contour of the eyelid can look different than the other, mostly on upper eyelids.
Too Much Skin
Another common cause of droopy eyelids is having excess skin, which can crowd into the eyelid, meaning there is no longer an eyelid platform. The platform is the strip of skin where makeup is often applied above the eyelashes. When there is too much skin, it can appear saggy and older, which Dr. Douglas emphasizes is not a thing that most people desire, leading to patients seeking out his ability to help improve this.
Eyebrows
Another component is often the eyebrows. As we age, the tail of the brow descends more rapidly, causing a sad look. Dr. Douglas states that one of the procedures he does often is raising the outside portion of the brows, which dramatically reduces the appearance of droopy eyelids in patients by creating a lifting up of the skin. The lift can be done in the office using botox, fat injections, fillers, or it can be done surgically with a brow lift.
The Difference in Patients’ Eyelids Between The Ages of 40 and 60
Dr. Douglas attests to the significant difference in appearance for patients in their mid 40s/50s who desire a more youthful and natural appearance. He states that treatment may include removing a bit of skin to address the droopy appearance, in order for the eyelid to look appropriate.
Treatment Options for Droopy Eyelids
Non-Surgical Options
- Botox and Fillers: These can be used to lift the brow and surrounding skin for temporary results.
- Non-invasive Devices: Eyelid lifting strips or special glasses with a lifting support can hold the eyelid in a better position for temporary relief.
Surgical Options
- Blepharoplasty (Eyelid Surgery): A common and effective procedure to remove excess skin, fat and muscle from the upper or lower eyelids. Recovery is quick and results are long lasting.
- Ptosis Surgery: Ptosis repair surgery tightens or repositions the levator muscle to lift the eyelid.
- Lifting Procedures: For some patients, a lateral brow lift or endoscopic brow lift may be more appropriate especially if the heaviness is more related to the brow than the eyelid itself.
Droopy Eyelid Recovery and Aftercare
After any eyelid treatment, especially surgery, patients can expect some bruising, swelling or mild discomfort. Cold compresses, rest and prescribed medications can help. Dr. Douglas recommends avoiding strenuous activity for at least a week after surgery and all follow up appointments to ensure proper healing. Most patients are back to normal in 10-14 days with results continuing to improve over time.
Contact Dr. Douglas Today For Your Thyroid Eye Disease Consultation!
If you or someone you know is suffering from thyroid eye disease, contact our office today to schedule an appointment with Dr. Douglas – (310) 657-4302. If you do not live in Los Angeles, ask us about our Out-of-Town Patient programs.
Frequently Asked Questions
What is a “droopy eyelid”?
A “droopy eyelid,” medically known as ptosis, is when the upper eyelid droops lower than normal. It can affect one or both eyes and may range from mild (barely noticeable) to severe enough to obstruct vision. Ptosis can occur in both children and adults.
Does ptosis always need treatment?
Not always. Mild cases that don’t affect vision or cause cosmetic concern may not require treatment. In these cases, your doctor may recommend observation and regular checkups to monitor changes over time.
Can ptosis be treated with eye drops?
Yes, in some adults with acquired ptosis, prescription eye drops such as oxymetazoline (Upneeq®) may help lift the eyelid temporarily. However, not all types of ptosis respond to drops. Your specialist can determine if this option is appropriate.
What are ptosis crutches or special glasses?
Ptosis crutches are small attachments added to eyeglasses that hold the eyelid up mechanically. They don’t treat the underlying cause but can be a useful temporary or non-surgical solution, especially for patients who aren’t candidates for surgery.
Can ptosis cause vision problems in children?
Yes. In children, untreated ptosis can block vision and lead to amblyopia (droopy eye) or a permanent reduction in vision development. Early diagnosis and treatment by an ophthalmologist are essential to prevent long-term visual impairment.
How is the best treatment for ptosis determined?
Treatment depends on the underlying cause and severity of the drooping. A thorough evaluation helps identify whether the issue stems from aging, nerve problems, muscle disorders, or trauma, guiding whether observation, medication, or surgery is most effective.
Why does my eyelid droop more at some times than others?
Fluctuating drooping may be linked to muscle fatigue or conditions like myasthenia gravis, which affect how muscles respond to nerve signals. If your ptosis seems to change throughout the day, it’s important to tell your doctor, as this can help with accurate diagnosis.
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