What Is Ptosis?

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Ptosis is an uncommon condition that mainly affects the upper eyelid and the eyelid muscle. The severity of the condition varies from a slight droop of the eyelid skin to excess eyelid skin completely covering the pupil and obstructing vision.

Ptosis is a medical condition where the upper eyelid of one, or sometimes both eyes, droops or sags. This condition can be either congenital and apparent at birth or within the first year of life, or acquired later in life due to the aging process, trauma, or other medical conditions. If ptosis develops in one eye it is called unilateral ptosis, if both eyes are affected it is bilateral ptosis.

Read on to learn about the different types of ptosis and the many causes, discover the signs and symptoms, how ptosis is diagnosed and managed and the treatment options available. Risk factors will also be discussed later in the article. Can ptosis be fixed with ptosis repair surgery? Can eye surgery, such as cataract surgery even be a risk factor for developing this eye muscle disease? Normal vision is something we often take for granted and any eye condition, particularly one that causes vision problems can be extremely distressing.

Overview

The term ‘ptosis’ comes from the Greek meaning ‘falling’ or ‘dropped’ and is often associated with other conditions that affect the muscular and nervous systems.1 Often, ptosis is associated with eye muscle disease. It can be congenital and present at birth or can be caused by trauma, or be associated with the general aging process.2

Causes of ptosis

There are two broad categories of ptosis, ‘true ptosis’ and ‘pseudoptosis’.2

True ptosis can be a congenital condition, meaning it is present at birth or presents within the first year of life, or can be an acquired condition that develops later on in life.1,2

Congenital ptosis occurs during the development of the eye muscle, levator palpebrae superioris, (the muscle which raises the upper eyelid and maintains its position) is somehow impaired.1
Causes of congenital ptosis

Underlying causes for congenital ptosis include:1

Causes of acquired ptosis

There are five types of acquired ptosis as discussed below.

Pseudoptosis

This is when the eyelid appears to be drooping but is unrelated to any neurological or musculoskeletal eyelid defects.5 Pseudoptosis may be caused by an abnormal-sized eye or other factors that do not relate to the eyelid mechanisms.

Signs and symptoms of ptosis

  • Drooping of the eyelid is the main sign and this can vary between individuals
  • Head tilting to see under the eyelid
  • Repeatedly raising the eyebrow to lift the eyelid
  • The affected eye appears smaller
  • Other symptoms relating to the underlying conditions
  • Impaired vision 
  • Dry eyes

Management and treatment for ptosis

Management and treatment of ptosis will depend on the cause of the condition, the severity of the effects, and the functioning of the muscle involved. Ptosis treatment may not be necessary if the ptosis is slight and not interfering with vision.

  • Stimulation of the muscle by exercising the muscle using electrical or mechanical stimulation6
  • Administration of medicated eye drops6
  • Taping up of the brow or eyelid to improve vision or a ptosis crutch6
  • Surgery is appropriate for congenital ptosis and where non-surgical treatments are not appropriate1,2

Diagnosis of ptosis

The following measurements are used to assess ptosis.7

  • Levator muscle function
  • Margin-reflex distance: distance between the upper lid margin and the corneal light reflection (when shining a torchlight to the eyes by your doctor or the examiner)
  • Palpebral fissure height: distance between the upper lid margin and the lower lid margin
  • Margin crease distance: distance between the skinfold of the upper eyelid and the upper eyelid margin

Risk factors

Being middle-aged or elderly is the main risk factor for developing ptosis. The following can also increase the chances of developing this condition.

  • Injury or stretching of eyelid muscles or ligaments
  • Damage to the nerve controlling the eyelid muscles
  • Complications of eye surgery
  • Genetic factors
  • Accidental stretching or tearing of the levator muscle
  • Contact lenses
  • Eye rubbing
  • Other underlying health conditions

FAQs

Can ptosis be prevented?

It is important to be aware of the risk factors and underlying health conditions that are associated with ptosis, but in most cases, this condition cannot be prevented.

How common is ptosis?

Congenital ptosis is the most common form of this condition, and the most common type of acquired ptosis is aponeurotic. There isn’t enough data on the incidence of ptosis to offer statistical figures, but it isn't a very common condition.

When should I see a doctor?

Make an appointment with your doctor if you notice any drooping of your eyelid, however severe. Any problems with vision or discomfort in the eye should be investigated by a medical professional. It is also important to monitor other underlying health conditions that may be risk factors in the development of ptosis. If you are a parent of a newborn or a young baby, then any unusual appearance of the eye should be investigated by a doctor.

Summary

Ptosis is not a very common condition, and some of the causes of ptosis are very rare. The main characteristic of ptosis is the drooping of the upper eyelid, and treatment will depend on the severity of the drooping and the impact on vision and appearance. An eye specialist will be able to diagnose and manage the condition.

References

  1. Shukla UV, Patel BC. Congenital ptosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK568688/
  2. Finsterer J. Ptosis: causes, presentation, and management. Aesth Plast Surg. 2003 Jun 1;27(3):193–204. Available from: https://doi.org/10.1007/s00266-003-0127-5
  3. Kamili MA, G A, Dar IH, Dar SH, Wazir HS, Qureishi T. Orbital pseudotumor. Oman J Ophthalmol. 2009;2(2):96–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905189/
  4. Finsterer J. Mitochondriopathies. Eur J Neurol. 2004 Mar;11(3):163–86. Available from: https://pubmed.ncbi.nlm.nih.gov/15009163/
  5. Harmon DM, Almarzouqi SJ, Morgan ML, Lee AG. Pseudoptosis. In: Schmidt-Erfurth U, Kohnen T, editors. Encyclopedia of Ophthalmology. Berlin, Heidelberg: Springer; 2018. p. 1464–5. Available from: https://doi.org/10.1007/978-3-540-69000-9_1272
  6. King M. Management of ptosis. J Clin Aesthet Dermatol. 2016 Dec;9(12):E1–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300727/
  7. Shahzad B, Siccardi MA. Ptosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK546705/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Victoria Ward

BSc, Herbal Medicine,University of Lincoln

Experienced Medical Herbalist BSc (Hons) and former nurse, highly knowledgeable about healthcare and medicinal plants. I’m especially interested in skin care and gut health. Regular blogger for my own website and freelance article writer. I enjoy writing both creative, ghostwriting and medical writing. Passionate about country life, have two horses and a collie dog.

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