What causes ptosis, and how is it fixed?

Ptosis refers to the drooping of the upper eyelid, which can affect one or both eyes. It may be present from birth (congenital) or develop later in life (acquired). While it is often harmless, ptosis can interfere with vision, cause eye strain or affect appearance and confidence. Understanding the causes of ptosis and the treatment options available is important for anyone experiencing eyelid drooping.

What are the main causes of ptosis?

Ptosis occurs when the muscles responsible for lifting the eyelid (primarily the levator muscle) are weakened, stretched or disconnected. Several factors can lead to this:

• Ageing: The most common cause in adults is age-related stretching or thinning of the levator muscle or tendon. This is known as involutional ptosis.
• Congenital ptosis: Some individuals are born with a poorly developed levator muscle. This can affect vision early in life if untreated.
• Neurological conditions: Diseases such as myasthenia gravis, third nerve palsy or Horner’s syndrome can interfere with the nerves or muscles that control eyelid movement.
• Trauma: Injury to the eyelid or previous surgery (such as cataract surgery) can damage or weaken the eyelid muscles.
• Contact lens use: Long-term use of hard or soft contact lenses has been linked to stretching of the eyelid structures.
• Tumours or cysts: Growths around the eyelid can add weight or affect the nerve supply.

When should ptosis be treated?

Ptosis should be assessed when it:

• Affects the visual field or interferes with daily activities
• Causes significant cosmetic concern
• Is linked to a sudden change in appearance (which may suggest a neurological issue)
• Develops in childhood and risks delaying visual development

In children, early treatment may be necessary to prevent amblyopia (lazy eye). In adults, the decision to treat is often based on severity and impact on lifestyle.

How is ptosis diagnosed?

An ophthalmologist or oculoplastic surgeon will conduct a thorough examination that includes:

• Measuring the eyelid position
• Testing eye muscle function and vision
• Checking for any underlying neurological or systemic cause
• Reviewing medical and surgical history

In some cases, additional tests such as blood tests or imaging may be required to rule out other conditions.

How is ptosis corrected?

The primary treatment for ptosis is surgery, which is tailored to the cause and severity of the droop:

Surgical options include:

• Levator advancement or resection: The most common technique, where the levator muscle is shortened or reattached to lift the lid
• Frontalis sling: Used in cases of poor muscle function, this connects the eyelid to the forehead muscle, allowing the patient to raise the lid by lifting their brow
• Müller’s muscle surgery: Suitable for mild ptosis with good levator function, this involves shortening an internal eyelid muscle

Non-surgical options such as ptosis crutches (eyeglass attachments) are rarely used but may help in selected cases.

Is ptosis surgery effective?

Ptosis surgery is usually successful, improving both appearance and vision. Most patients recover well, though mild asymmetry, swelling or temporary dryness may occur. An experienced specialist can help guide the choice of procedure and discuss realistic outcomes.