Eyelid ptosis, medically known as blepharoptosis, is generally not a major concern and can be treated in most cases. It refers to a condition where one or both upper eyelids droop over the eye. Usually, this disorder does not cause serious problems, and healthcare providers can treat most cases with a simple surgical procedure.

However, the role of the eyelids should not be underestimated. The upper and lower eyelids play a crucial role in protecting the eyes from injury. They also help control the amount of light entering the eyes and ensure that the tear film covers the eyes to prevent dryness.

Various factors can lead to eyelid ptosis, including aging, muscle weakness, and congenital diseases (diseases present at birth). The following are some common causes and risk factors of eyelid ptosis:

Some babies are born with eyelid ptosis, and healthcare providers can address this issue. In fact, it should be treated promptly. As Dr. Philip Rizzuto, an ophthalmic plastic surgeon and a spokesman for the American Academy of Ophthalmology, told Health magazine, "If there is a problem with the eyelid, a child's vision will not develop normally. When a child sees colors and light, all the nerves are stimulated. The retina and the brain form pathways that lay the foundation for lifelong vision." Strengthening the eyelid muscles through surgery can effectively prevent complications such as amblyopia, astigmatism (blurred vision), and strabismus.

Nerve damage caused by eyelid injury or diseases that affect the brain and nervous system can lead to eyelid ptosis. Horner syndrome is one such disorder. Horner syndrome is a rare syndrome that occurs when the eye nerve is somehow disrupted. The causes of Horner syndrome can be diverse and may include tumors, spinal cord trauma, brain injury, and swollen lymph nodes. Sometimes, the cause of Horner syndrome may be unknown, which is called idiopathic. Some evidence suggests that the disease can be inherited. Generally, Horner syndrome also causes the pupil to become smaller. The affected side of the face may be dry and without sweating. Eyelid ptosis caused by Horner syndrome usually disappears after the underlying problem is treated. In addition, nerve damage caused by long - term uncontrolled diabetes and hypertension can also lead to eyelid ptosis. Therefore, it is very important to identify and treat these conditions.

There are mainly three muscles that control the movement of the eyelids. The most important one is the levator palpebrae superioris muscle. Anything that affects these muscles can interfere with the normal operation of the eyelids. Oculopharyngeal muscular dystrophy (OPMD) is a rare disease that affects the eye muscles. In addition, OPMD can also damage the swallowing muscles and even some limb muscles. Chronic progressive external ophthalmoplegia (CPEO) is another disorder that affects both eyes. CPEO can lead to the loss of eye muscle function and eyelid movement.

One of the most common causes of eyelid ptosis is aponeurotic eyelid ptosis, also known as degenerative eyelid ptosis, which is more common in the elderly. Frequent rubbing of the eyelids may cause aponeurotic eyelid ptosis. As Dr. Rizzuto said, "Gravity and time cause everything to move downward, sometimes resulting in eyelid ptosis. Sometimes, the extra skin on the eyelid hangs over the eyelid and blocks the vision." In most cases, it is only a cosmetic problem. If desired, elective surgery can at least partially restore the youthful appearance of the eyelids. Sometimes, drooping eyelids can affect vision. In such cases, surgery may be needed to maintain vision.

Today, healthcare providers are very skilled in performing different types of eye surgeries, and the incidence of surgical complications is extremely low, but it is still possible. If the complication is eyelid ptosis, it is called postoperative eyelid ptosis. Dr. Jessica Zwerling, an associate professor of neurology at the Albert Einstein College of Medicine, told Health magazine, "After cataract surgery, the levator palpebrae superioris muscle of the eyeball may separate over time." There have been reports of eyelid ptosis after cataract, corneal, refractive (such as LASIK), and glaucoma surgeries. Experts are not sure about the specific reasons for eyelid ptosis after surgery. However, the instruments used by surgeons and the type of anesthesia may play a role.

Myasthenia gravis is a rare autoimmune disease that affects the communication between muscles and nerves, leading to muscle weakness. Eyelid ptosis is usually one of the early symptoms of the disease. In patients with myasthenia gravis, the antibodies that are usually used to fight invaders such as viruses become ineffective. These antibodies prevent muscle cells from receiving the messages sent by nerve cells. Dr. Zwerling pointed out, "The symptoms of eyelid ptosis change constantly throughout the day. You may also have double vision. It can also affect other muscles." Myasthenia gravis cannot be completely cured, but lifestyle changes and medications can control the symptoms of muscle weakness.

Cancer that occurs inside the eye usually does not affect the eyelids. However, cancer around or outside the eye can affect the muscles that raise and lower the eyelids. These include tumors that grow along the eye nerve or artery or in the muscles that control the eye. Eyelid ptosis is also a very rare complication of metastatic cancer (such as breast cancer or lung cancer) in extremely rare cases.

The most obvious symptom of eyelid ptosis is the drooping of the eyelid. Other possible symptoms may include: difficulty opening the eyes, eye fatigue, tearing, forehead pain when looking up, eye fatigue, inability to see clearly without tilting the head backward or lifting the chin, amblyopia (sometimes called "lazy eye" because one eye seems to be looking in another direction), strabismus (the eyes cannot align properly), astigmatism, visual double vision, blurring or distortion.

An ophthalmologist will ask about the patient's medical history, symptoms, and whether they have recently encountered other health problems or injuries. They will conduct a comprehensive eye examination to assess the overall eye health of the patient. The ophthalmologist will also check for any abnormalities in the pupil, as such abnormalities sometimes occur in patients with eyelid ptosis. In addition, they can test the function of the eye muscles by asking the patient to look in different directions. The ophthalmologist can measure the degree of eyelid ptosis by measuring the distance between the center of the pupil and the edge of the upper eyelid. They will also test the strength and function of the levator palpebrae superioris muscle. If the ophthalmologist believes that the patient's eyelid ptosis is caused by an underlying disease, they may request a blood test. They may also refer the patient to a neurologist to rule out other causes.

If the eyelid ptosis is caused by an underlying disease (such as myasthenia gravis), treating the disease usually improves or stabilizes the eyelid ptosis.

If it is not caused by an underlying disease, healthcare providers usually treat the drooping eyelid with surgery. The surgeon will adjust, strengthen, or even reconnect the muscles that control the movement of the eyelids. The surgery is performed under local anesthesia, and the patient can go home on the same day. For children or infants with eyelid ptosis, the surgical methods include strengthening the muscles if they still have some function. If there is no function, the surgeon will use an implant. As Dr. Rizzuto said, "It is basically a sling that supports the eyelid."

In 2020, the US Food and Drug Administration approved Upneeq (oxymetazoline hydrochloride eye drops). Upneeq is one of the first prescription eye drops to treat certain types of eyelid ptosis by tightening the muscles. It is only applicable to eyelid ptosis caused by aging or certain cosmetic surgeries.

A study published in the Journal of Clinical and Aesthetic Dermatology in 2018 found that Botox injections can treat mild eyelid ptosis.

If a patient does not need or want surgery, they can wear a pair of glasses with a "bracket" to support the upper eyelid. Or they can also consider wearing an eye patch.

In conclusion, aging or certain diseases can cause eyelid ptosis. In some cases, babies are born with eyelid ptosis. Eyelid ptosis is usually not a serious problem, but in some cases, it can affect vision. A simple surgical procedure can treat most cases of eyelid ptosis. If the eyelid ptosis is related to an underlying disease, treating the disease may improve the eyelid ptosis. If the symptoms develop rapidly within a few days or hours and are accompanied by weakness in the arms, legs, or face, severe headache, or double vision, please contact an ophthalmologist immediately.