What is ptosis?
Ptosis is when the upper eyelid
droops down over the eye. If the ptosis is severe, it may block vision.
There is one main muscle that opens
the eyelid (levator palebrae superioris). Another muscle helps the eye open even more
(superior tarsal muscle). If there is a problem with either of these muscles or their
nerves, ptosis can occur. The eyelid muscles stay relaxed, and the lid hangs down over
Sometimes the condition is present
from birth. This kind of ptosis is often due to a problem with the levator palpebrae
superioris muscle. Other times, ptosis happens later in life because of other health
conditions. Healthcare providers often group ptosis according to the age when it occurs
and the underlying cause. Ptosis that is due to a problem with the levator palpebrae
superioris muscle is often more severe than if it is due to a problem with the superior
Ptosis is not very common. The most
common form that is present from birth is due to poor development of the levator
palpebrae superioris muscle. It may affect one or both of the eyelids.
What causes ptosis?
Ptosis happens when the levator
palpebrae superioris muscle does not contract correctly. It can also happen when the
superior tarsal muscle does not contract correctly. Many kinds of conditions can cause
this. For example, ptosis may be caused by:
Structural problems with the muscle that are present from birth
Muscle disorders (such as
mitochondrial myopathy or myotonic dystrophy)
Rare disorders present from birth
(such as congenital orbital fibrosis)
Problems with the tendon attached to the superior tarsal muscle
Senescence, dehiscence, or disinsertion of the levator aponeurosis
Too much weight on the eyelid (such as
from an eyelid tumor)
Injury (especially during eye
Nerve problems (such as with the third
cranial nerve or in Horner syndrome)
Connection problems between the muscle
and the nerve (such as in myasthenia gravis)
Some eye problems may look like
ptosis even if there is no problem with the eyelid itself. For example, older adults may
have extra eyelid skin and loss of fat around the eye. This can look like ptosis.
Who is at risk for ptosis?
Ptosis from certain causes may run
in families. If another family member has had ptosis, it may be more likely that you or
your child will have it. Having a health condition that can cause ptosis may raise the
risk for it.
What are the symptoms of ptosis?
The main symptom is a droopy
eyelid. Depending on the cause, one or both eyelids may droop. In some cases, the eyelid
may be so low that it partly blocks vision. This may delay vision development in some
children if not corrected.
The most common kind of ptosis
present from birth often affects only one eyelid. But both may be droopy. Some other
symptoms seen in this type can include:
Ptosis due to other causes can have
other symptoms. For example, there may be damage to the third cranial nerve. This can
cause problems with eye movement and the pupil’s response to light. This can be a sign
of a stroke. Medical care is needed right away.
How is ptosis diagnosed?
Your eye healthcare provider will
take a health history and do a physical exam. This will include a full eye exam. Your
provider will take special note of the eyelid position. He or she will also look at any
eye abnormalities or any problems with the nervous system or muscles.
After this, your eye healthcare
provider will likely have a good idea of what may be causing the ptosis. In some cases,
he or she may want to do some tests for more information. For example, the provider may
want more tests if your child may have a problem with the third cranial nerve. These
tests might give the provider more detailed information on the cause:
CT scan of the brain and third cranial
MRI of the brain and third cranial
Magnetic resonance angiography (MRA) of the brain and third cranial nerve
How is ptosis treated?
If your child has ptosis at birth,
the eye healthcare provider may choose to watch your child for vision problems. In some
cases, ptosis gets better over time as the facial structure develops. But some children
will need surgery if this does not improve.
If your child’s ptosis is more
severe, the provider may advise surgery right away. This is more likely if the eyelid is
severely blocking vision.
Your child may also need treatment
for the other symptoms that are often present with ptosis. For example, your child may
need to wear glasses to correct astigmatism. If your child develops lazy eye
(amblyopia), he or she might need to wear an eye patch over the eye with the normal
Other treatments are done for some
kinds of ptosis that happen later in life. For example, your child's ptosis may be due
to myasthenia gravis. Then your child may need to take a kind of medicine
(acetylcholinesterase inhibitor). Many kinds of ptosis are not treatable with medicines.
Your child may need to wear glasses with special wires to help keep the eyelid from
People who get ptosis later in life also may need surgery. This is often the case with severely impaired vision and other failed treatments. You may also want surgery for cosmetic reasons. Talk to your eye healthcare provider about the risks and benefits of all your treatment choices.
What are possible complications of ptosis?
If ptosis blocks vision, it may
delay visual development. So eye healthcare providers often advise surgery for severe
ptosis in children. You will need careful follow-up with your child’s eye healthcare
provider. This is to make sure the ptosis is not significantly affecting your child’s
The surgery to correct ptosis can
sometimes cause problems. The most common of these is not being able to fully close the
Key points about ptosis
Ptosis is when the upper eyelid droops down over the eye more
than it should. In some cases, it can cause major vision problems.
It is often present from birth. This
is often due to a problem with a main eyelid muscle.
Sometimes it happens later in life.
This may be due to problems with the eyelid muscles, nerves, or something weighing
down the eyelid.
Your child's eye healthcare provider
may choose to watch your child’s ptosis. If so, your child will need careful
follow-up so there is no delay in visual development.
Surgery may be needed if ptosis is
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.