What you should know about droopy eyelids

Clinically reviewed by: Optum National Clinical Review Team

Our eyes are thought to be one of our most effective means of non-verbal communication. They also may be one of the sincerest parts of the face because they convey our emotions often involuntarily. But what if droopy upper eyelids cover your eyes or hinder your vision preventing you from seeing the eyes of others?

Droopy upper eyelids, referred to as ptosis in medical language, can both impede this non-verbal communication and more importantly block vision, creating serious safety and quality of life issues. For some, having droopy eyelids may not hinder the ability to see others, but could impact appearance including how you see yourself, making you appear tired, sleepy, or older than you really are. Droopy eyelids that limit or block vision should be diagnosed and managed by a medical professional.

Why does ptosis occur?

Age-related skin changes over many years can take their toll on the levator muscle, which allows for the eye to open and close, causing it to separate from its insertion on the eyelid.^1,2 This is known as acquired ptosis. Children can be affected by ptosis at birth, or congenital ptosis. This condition is due to levator palpebrae superioris, or the muscle that helps raise the eye and maintain position, doesn’t develop properly.¹ Other causes of acquired ptosis include:

• Traumatic injury or stretching of the levator muscle^2,3
• Damage to the nerves that control the eye muscle^2,3
• Eye surgery complications²
• Stretching or tearing of eye lid muscles or ligaments²

Another cause of droopy upper eyelids is called “dermatochalsis”. As your skin loses its normal stretchiness and the upper eyelid tissue weakens with age, you may have the appearance of extra skin that “weighs” the eyelid down, creating a “hooding” effect.⁴

What are the treatment options?

Whether you are bothered by the appearance or have trouble seeing due to droopy eyelids, it is important to know that both ptosis and dermatochalasis are treatable. Your primary care physician can recommend an eye specialist who will conduct a thorough examination to determine the cause of your droopy eyelid(s). An eye doctor who specializes in problems with the eyelids is known as an oculoplastic surgeon.⁵ Depending on the severity, your physician can recommend either surgical or non-surgical treatment options.

For severe ptosis, surgery may be recommended to strengthen and tighten the levator muscle to improve the field of vision and appearance.³ Medication such as the daily use of oxymetazoline eye drops may be prescribed to help open and widen the eye. However, be sure to ask your doctor if medication is right for you as it may not be effective for every case such as those resulting from injury or nerve problems.^3,6 For dermatochalasis, surgery (upper eyelid blepharoplasty) involves removing and sculpting the excessive upper eyelid skin in a manner that still allows for good eyelid closure, restoration or improvement of physical appearance (comesis), and symmetry between both eyelids.^4,7 These are usually outpatient procedures with a return to home on the same day. Recovery is variable, but for most patients, it takes about one to two weeks. Minor bruising or swelling can be expected and will likely resolve during that time.

In considering ptosis surgery, patients should understand that even the most skilled surgeon cannot control all the variables that determine the final position of the eyelid. It’s possible the eyelid will be higher or lower than desired, which can be revised at a later point once swelling has resolved. As with any surgery there is potential risk for occurrence of complications such as bleeding and infection, though this is uncommon. Be sure to talk to your doctor about all of the risks and benefits of surgery.

Disclaimer:

The information featured in this site is general in nature. The site provides health information designed to complement your personal health management. It does not provide medical advice or health services and is not meant to replace professional advice or imply coverage of specific clinical services or products. The inclusion of links to other web sites does not imply any endorsement of the material on such websites.

1. Ptosis. https://aapos.org/glossary/ptosis. Updated March 20, 2023. Accessed April 27, 2023.
2. Ptosis. https://www.aoa.org/healthy-eyes/eye-and-vision-conditions/ptosis. Accessed April 27, 2023.
3. What is Ptosis. https://www.aao.org/eye-health/diseases/what-is-ptosis. Published September 9, 2022. Accessed April 27, 2023.
4. Dermatochalasis. https://eyewiki.aao.org/Dermatochalasis. Last updated April 22, 2023. Accessed April 27, 2023.
5. Ophthalmology Subspecialists. https://www.aao.org/eye-health/tips-prevention/ophthalmology-subspecialists. Published Feb. 24, 2023. Accessed May 11, 2023.
6. UPNEEQ- oxymetazoline hydrochloride ophthalmic solution/ drops. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cf6c9a1f-2367-46d2-99c3-c7d67ec6f519&audience=consumer. Updated July 21, 2022. Accessed May 11, 2023.
7. Upper Eyelid Blepharoplasty. https://eyewiki.aao.org/Upper_Eyelid_Blepharoplasty. Last updated October 30, 2022. Accessed April 27, 2023.