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Drooping Eyelids (Ptosis): 10 Causes, Treatments & Statistics

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Last updated June 11, 2022

Drooping eyelid quiz

Take a quiz to find out what's causing your drooping eyelid.

Drooping of one or both eyelids can interfere with vision if severe. In some cases it is present from birth and in others it has a gradual or rapid onset.

Drooping eyelid quiz

Take a quiz to find out what's causing your drooping eyelid.

Take drooping eyelid quiz

Drooping eyelid symptoms

Drooping of one or both eyelids can be an irritating symptom, regardless of how long the patient has been experiencing it. Eyelid drooping can present upsetting changes to the appearance of the face and even interfere with vision if severe. In some cases, it is present from birth. In other cases, it develops later in life, with a gradual or rapid onset depending on the cause.

Common accompanying symptoms of a drooping eyelid

If you're experiencing a drooping eyelid, it's also likely to experience:

  • Small pupil and lack of sweating
  • Enlarged pupil
  • Decreased ability to move the eye
  • Headache
  • Muscle weakness
  • Blurry vision
  • Eye pain, itching, or discharge

Drooping eyelid causes

Congenital Drooping Eyelid Causes:

Drooping of one or both eyelids can be present from birth and is called congenital ptosis. Usually this is a benign condition with no identifiable cause, but occasionally it can be a sign of an underlying medical condition.

Neurological conditions

Certain neurological conditions can result in a drooping eyelid.

  • Peripheral nerve damage: Injury to peripheral nerves that contribute to eyelid function can lead to drooping eyelid symptoms. This can occur via trauma to a major artery in the neck or compression by a tumor in the lung. There may be additional symptoms such as a constricted pupil and lack of sweating.
  • Decreased blood flow: Obstruction of blood supply in certain areas of the brain, such as during a stroke, can lead to drooping of one or both eyelids.
  • Structural abnormality in the brain: An aneurysm, meaning an enlarged portion of a blood vessel, can compress a major nerve that supplies the eye and eyelid (the oculomotor nerve). This causes eyelid drooping, decreased ability to move the eye, and an enlarged pupil. A similar process can occur due to a brain tumor.

Muscular conditions

The following muscular conditions may result in a drooping eyelid.

  • Neuromuscular condition: Communication between nerves and muscles can be disrupted by an inappropriate immune response. This results in muscle weakness, including in the muscles that hold up the eyelid.
  • Aging: The muscular structures that hold up the eyelid can gradually degenerate over time, leading to drooping eyelid symptoms.

Eye or eyelid conditions

Eye conditions can result in a drooping eyelid.

  • Infection: An infection of the eye socket can lead to eye pain, difficulty moving the eye, and a drooping eyelid.
  • Eyelid abnormality: A structural abnormality, such as a tumor or thickening caused by an allergic eye disease, can cause droopiness by weighing down the eyelid.

Underlying medical conditions

Certain underlying medical conditions can result in a drooping eyelid.

  • Diabetes: As diabetes progresses, small blood vessels can be damaged, including ones that supply the oculomotor nerve. Disruption of the blood supply can cause a drooping eyelid along with decreased ability to move the eye.
  • Headache syndromes: Some headache syndromes can present with eyelid drooping as an additional symptom.
  • Thyroid disease: Abnormally high levels of thyroid hormone (hyperthyroidism or Grave's Disease) are more likely to cause pulled back eyelids than droopiness. However, in some cases, high thyroid hormone can cause the same neuromuscular disorder mentioned above, causing droopy eyelids.

This list does not constitute medical advice and may not accurately represent what you have.

Myasthenia gravis (over 50)

Myasthenia Gravis is an autoimmune disease, where the immune system attacks the connection between nerves and muscles.

Rarity: Rare

Top Symptoms: weakness, general weakness, trouble swallowing, voice change, double vision

Urgency: In-person visit

Drooping eyelid quiz

Take a quiz to find out what's causing your drooping eyelid.

Take drooping eyelid quiz

Stye or chalazion

A stye (or hordeolum) is an infection in the upper or lower eyelid. There are three glands around the eye and one of them is infected.

You can treat this on your own with a topical antibiotic and warm compresses to help drain the infected area.

Stroke or tia (transient ischemic attack)

Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.

Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.

Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.

A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.

Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.

Rarity: Common

Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck

Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness

Urgency: Emergency medical service

Mitochondrial myopathy

Mitochondrial myopathy includes a group of inherited genetic disorders that affect the muscles of the body.

Make an appointment with a physician to further analyze what genetic defects may be present, and begin prescription treatment.

Irritated eye causing swelling

Chemosis is a sign of eye irritation. The outer surface of the eye can look like a blister, filled with water or fluid. It can occur from infection or allergies, or as in this case, from rubbing the eye.

You can treat this on your own with eye drops from the pharmacy. "Antihistamine" drops like Zaditor (ketotifen fumarate) or Optivar (azelastine hydrochloride) will sooth and reduce swelling.

Inflamed eyelid (blepharitis)

Inflamed eyelid, or blepharitis, is a bacterial infection of the skin at the base of the eyelashes.

If the oil glands around the eyelashes become clogged, normal skin bacteria will multiply in the oil and cause infection. The glands can become blocked due to dandruff of the scalp and eyebrows; allergies to eye makeup or contact lens solution; or eyelash mites or lice.

Symptoms include red, swollen, painful eyelids; oily, dandruff-like flakes of skin at the base of the eyelashes; and eyelashes that grow abnormally or fall out.

If the symptoms do not clear with hygiene, see a medical provider. Blepharitis can become chronic and lead to infections of the eyelids and cornea; dry eyes which cannot take contact lenses; and scarring and deformity of the eyelids.

Diagnosis is made through physical examination of the eyelids, under magnification and through skin swab of the eyelashes.

Treatment includes warm compresses and careful washing of the eyelids; antibiotics in pill or cream form; steroid eyedrops; and treatment for any underlying condition such as dandruff or rosacea.

Hypothyroidism

Hypothyroidism, or "underactive thyroid," means that the thyroid gland in the neck does not produce enough of its hormones. This causes a slowing of the body's metabolism.

The condition can occur due to autoimmune disease; any surgery or radiation treatment to the thyroid gland; some medications; pregnancy; or consuming too much or too little iodine. It is often found among older women with a family history of the disease.

Common symptoms include fatigue, constantly feeling cold, weight gain, slow heart rate, and depression. If left untreated, these and other symptoms can worsen until they lead to very low blood pressure and body temperature, and even coma.

Diagnosis is made through a simple blood test.

Hypothyroidism is easily managed with daily oral medication. The patient usually starts feeling better after a couple of weeks and may even lose some extra weight. It's important for the patient to be monitored by a doctor and have routine blood testing so that the medication can be kept at the correct levels.

Cluster headache

A "new onset" cluster headache means that the person has never experienced a before. These headaches most commonly start after age 20.

A cluster headache is characterized by intense pain on one side of the forehead, especially over one eye. It often strikes in "clusters," meaning the headache comes and goes frequently. It may occur at about the same time of day for several days or weeks in a row.

The specific cause for cluster headache is not known. Drinking alcohol, breathing strong fumes, exercising to the point of becoming overheated, and heavy smoking are all possible triggers.

Diagnosis is made through patient history, since there is no specific test for cluster headache. Blood tests, neurologic tests, and imaging such as a CT scan or MRI may be done to rule out any other cause for the new onset of head pain.

Referral will be made to a headache specialist, who can offer new treatments to help the patient manage the symptoms and improve quality of life.

Rarity: Uncommon

Top Symptoms: severe headache, nausea, throbbing headache, history of headaches, sensitivity to light

Symptoms that always occur with cluster headache: severe headache

Urgency: Hospital emergency room

Carotid artery dissection

A carotid artery dissection is the tearing of the walls of the carotid arteries, which deliver blood to the brain from the aorta. This is a medical emergency.

Call 911 immediately. Diagnosis is done by CT or MRI, and treatment involves anti-clotting medication for at least 3-6 months. Surgery may be necessary for those who can't get this medication.

Drooping eyelid treatments and relief

When a drooping eyelid is an emergency

Seek emergency treatment if:

  • You are having difficulty breathing: You may have a neuromuscular condition that is affecting the muscles controlling respiration.
  • You are experiencing neurological abnormalities such as confusion or slurred speech
  • Your eyelid drooping started very suddenly
  • You have decreased ability to move your eye: Or, a constricted pupil and lack of sweating on the side of the drooping eyelid
  • You have a severe headache along with the drooping eyelid
  • You are experiencing eye pain and/or a fever

Drooping eyelid quiz

Take a quiz to find out what's causing your drooping eyelid.

Take drooping eyelid quiz

When to see a doctor for a drooping eyelid

In some cases, even though emergency treatment isn't necessary, you may need laboratory testing or radiology testing/imaging in order to make a diagnosis and select the best drooping eyelid treatment. Make an appointment with your medical provider if:

  • Your eyelid drooping has worsened over time: Or is affecting your ability to see
  • You have noticed muscle weakness in other parts of the body
  • You have symptoms of high thyroid hormone: Such as weight loss or changes in your menstrual cycle
  • You have noticed decreased peripheral vision
  • You have previously been diagnosed with diabetes or a thyroid condition

Medical treatments

Your medical provider may prescribe one or more of the following treatments, depending on the cause of your drooping eyelid symptoms:

  • Medication: This may be needed to suppress abnormal immune system activation or improve communication at the neuromuscular junction.
  • Treatment for an underlying medical condition: Such as diabetes or increased thyroid hormone
  • Referral to a surgeon

Treatment to address the drooping eyelid directly

Unfortunately, most causes of a drooping eyelid will not resolve without medical or surgical treatment.

  • For allergies: If you have been diagnosed with an allergic disorder of the eyelid, avoiding allergens can help with drooping and discomfort.
  • For neuromuscular conditions: Placing an icepack on the eye for a couple minutes can help improve eyelid drooping if a neuromuscular condition is the cause.

FAQs about drooping eyelid

Why is my eyelid drooping suddenly?

Sudden eyelid drooping, or ptosis, can have a variety of causes. Peripheral nerves that travel through the neck can be disrupted, causing eyelid drooping along with a constricted pupil and lack of sweating (triad of Horner's syndrome). The eyelid drooping could also be caused by an abnormality in the brain such as bleeding or a stroke. You should seek medical evaluation as quickly as possible, especially if you are having other symptoms such as blurry vision or different sized pupils.

Why does one of my eyelids droop more than the other?

You may have one eyelid that has drooped more than the other ever since you were born. In this case, there is unlikely to be any underlying medical cause. If the drooping eyelid develops later in life, it may be caused by a process occurring only on that side. Possible conditions include a tumor on the eyelid, nerve injury, or an infection.

Can drooping eyelids cause vision problems?

Severely drooping eyelids (ptosis) can obscure your vision by blocking the eyes. In addition, eyelid drooping in early childhood can cause long-term visual problems due to the brain favoring the unobstructed eye. A child with a drooping eyelid should be regularly monitored, and the eyelid should be surgically corrected if visual problems in that eye begin to develop.

Can a drooping eyelid be a sign of a stroke?

Sudden eyelid drooping (ptosis) is a possible sign of a stroke. Depending on the location of the stroke, one or both eyelids can be affected. If a stroke is the cause of eyelid drooping, other symptoms will often be present, such as one-sided weakness or blurry vision.

Hear what 3 others are saying
HeadachePosted February 11, 2022 by B.
Have had a headache in the back of my neck on the left side since Tuesday. Tylenol would not help; ibuprofen did. Now my left eye is kinda dropping but no headache right now. What should I do?
Exhausted eyesPosted May 30, 2021 by B.
While driving home from a meeting, I noticed a difference in my vision. I had to really concentrate to keep my focus on the road while driving home, which was 6 hours away. My eyes were so stressed, tired, and hurting that they wanted to go shut. I was by myself and really had to focus so my eyes would not go blurry. When I went into a canyon my eyes felt like the canyon walls were pulsing in toward my car. My eyes were exhausted when I got home. Today my left eye was so tired and strained and sore I had to keep shutting it to rest it while I was driving. I felt like the cord going into the back of my eye was tired, strained, and sore. Both eyes always hurt, but my right eye could be the worse eye tomorrow. They both always hurt but one eye one day is worse then they trade places. My eyes are red and my eyelids puffy. I’ve been to 4 specialists. I’ve got blue lens glasses, steroid drops, and dry eye drops. I’m wearing dark glasses all the time. Shutting my eyes and laying down for 20 minutes seems to be the only thing that helps. For the last going on three years, my eyes have hurt me every day!
Drooping eyelidsPosted April 13, 2021 by A.
It started after a stroke in 2014. My eyes started to become very dry and I used lubricating drops frequently. This seemed to have helped, but now it's 2021 and it's a lot worse, especially in one eye. After frequent visits to an optician, they said it was dry eye syndrome. I can hardly open my eyes in the mornings and have constant headaches and feel tired, even fatigued. I also use CPAP for severe sleep apnea and put it down to using this. However, now it appears that my right eye restricts my vision by half and the other is slowly going the same way. I have a telephone appointment with my GP to discuss this next week and hopefully will get an answer and some form of treatment. Maybe it's from getting older (66) or is it something else.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

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