Ptosis

What Is Ptosis?

Ptosis (TOE-sis) is drooping of the upper eyelid. Sometimes it's a symptom of another medical condition, but it also can happen by itself.

What Happens in Ptosis?

Normally, eyelids open when the brain sends a signal to the eyelid-lifting muscles. This signal is carried by nerves. Then, muscles lift the eyelids.

In ptosis, something goes wrong in this process, so one or both eyelids hang low. The problem could be:

• The brain or a nerve isn't working right. 
• The nerves and the muscles have a connection problem.
• The eyelid-lifting muscles are weak or missing.
• The eyelid muscle isn't attached to the eyelid properly.

Sometimes, the eyelid doesn't open at all. Ptosis can affect one eye or both eyes. 

What Problems Can Happen?

Eyelids can hang low enough to cover the pupil and block vision. This can lead to poor vision ("lazy eye" or amblyopia) or complete blindness. Some types of ptosis also are linked to problems in the light-sensitive part of the eye (retinopathy).

What Are the Signs & Symptoms of Ptosis?

A child with ptosis may:

• lift their eyebrows to raise the eyelids
• tilt the head back to see better
• say they have trouble seeing
• run into things hanging from overhead
• crawl or walk later than most children

Children with ptosis often have other eye-related symptoms, including:

• eyes that don't line up
• nearsightedness, farsightedness, or astigmatism
• double, blurred, or distorted vision
• eye strain, headaches, or dizziness

How Is Ptosis Diagnosed?

Doctors may notice ptosis when a baby is born. Other times, parents take their child to a doctor after they notice the drooping eyelids.

The doctor will ask about the child's medical history and do an exam. Doctors usually recommend more testing by:

• an eye specialist (ophthalmologist). The ophthalmologist will check the child's vision, take special eye measurements, and look for any swelling that might be pushing the eyelid down.
• a brain and nerve specialist (neurologist). The neurologist will test the blood, nerves, and muscles to check for other problems.

How Is Ptosis Treated?

The treatment for ptosis depends on:

• what's causing it and how severe it is
• the child's age, symptoms, and any other medical conditions

Doctors often treat ptosis with surgery to tighten the muscles that lift the eyelid. They also might strengthen a weaker eye by using eye drops, patching (putting a patch over the unaffected eye so that the weaker eye has to take over), or special glasses. Occasionally, they'll use a ptosis crutch, which is an eyeglass-like frame that supports the eyelid.

What Causes Ptosis?

There are many different types of ptosis, each with a different cause. Ptosis can happen when a child:

• has problems with the brain or nerves (for example, 3rd nerve palsy or Horner syndrome)
• has nerve problems that lead to muscle weakness (such as myasthenia gravis)
• is born with weak or missing eyelid muscles (congenital ptosis)
• has a birth defect or injury

How Can Parents Help?

If your child has ptosis, you can help by:

• Going to all follow-up doctor visits. They're important to help prevent vision loss.
• Giving medicine as prescribed. If you have trouble giving the medicine on schedule, let the doctor or nurse know.
• Watching for head-tilting. Tell the doctor if your child is head-tilting, which may be a sign that the eyelid is drooping.