Droopy eyelid (ptosis) in adults and children: when is surgery needed?

Why an eyelid droops

The upper lid is lifted by a muscle attached to it by a thin tendon. The causes of a droop fall into a few groups:

• Age: the tendon stretches or comes loose over the years. This is the most common cause in adults
• Long-term contact lens use, eye surgery or rubbing the eyes
• Present from birth: the lifting muscle did not develop fully
• Nerve problems, including diabetes affecting a nerve, or pressure on a nerve
• Muscle conditions such as myasthenia gravis, where the droop often gets worse through the day

When a droopy eyelid is an emergency

Go to an emergency department the same day if the droop:

• Came on suddenly, over hours or a day or two
• Comes with double vision, a large pupil, or the eye turning outward
• Comes with a severe headache, weakness of the face, arm or leg, or slurred speech
• Follows a head injury

Ptosis in children

A child born with a droopy lid needs to see an eye specialist early. If the lid covers the pupil, the brain may not learn to see properly from that eye, which is called lazy eye, and that can be permanent if not treated in time. Some children need surgery while young. Others are watched with regular sight checks and have surgery later. Do not wait for the child to grow out of it without a specialist's opinion.

Ptosis surgery or eyelid skin surgery?

Many adults with heavy-looking eyes have extra skin folding over the lid, not a weak lifting muscle. That is treated with a different operation, blepharoplasty, which removes skin. Some people have both problems. A proper assessment measures how far the lid edge sits over the pupil and how well the lifting muscle works, and that decides which operation is right.

Ptosis surgery itself usually shortens or re-attaches the lifting tendon, through a cut hidden in the eyelid crease. If the muscle is very weak, the lid may be linked to the forehead muscle instead, so raising the eyebrows lifts the lid. Adults usually have local anaesthetic, sometimes with sedation. Children usually need a general anaesthetic.

Recovery and what to expect

Bruising and swelling are normal for one to two weeks. Cold compresses, sleeping with your head raised, and ointment or drops help. Avoid heavy lifting and dusty places for the first week. Stitches, if they need removing, usually come out within about a week.

The two lids may not match perfectly, and a small number of people need a further adjustment. For a while you may not close the eye completely during sleep, which is why lubricating drops or ointment are often given. Your surgeon will tell you what result to expect for your type of ptosis.

Common questions