Droopy eyelids
What are drooping eyelids?
"Drooping eyelids" is not a single condition - it encompasses several different conditions that may look similar, but have different causes and treatments.
Ptosis is drooping of the upper eyelid due to weakness or damage to the muscle that lifts the eyelid. The eyelid hangs lower than it should and narrows the opening between the eyelids. In an attempt to lift the eyelid, patients often unconsciously raise their eyebrows and tilt their head backwards.
Dermatochalasis is a condition in which excess skin accumulates on the upper (and sometimes lower) eyelids with age. The skin becomes loose and lax - giving a tired and older appearance. In more pronounced cases it can press on the lashes and lead to narrowing of the visual field.
How do they develop?
Ptosis may be congenital (present from birth) or acquired during life. Acquired ptosis most commonly develops as a result of the natural ageing and weakening of the eyelid muscle - known as senile ptosis - but may also be the result of neurological conditions, injury, or long-term use of contact lenses.
Dermatochalasis is almost always a consequence of ageing - loss of skin elasticity and weakening of the orbital septum that holds the eyelid tissues in place. It may be genetically determined - the same condition is seen across several generations of the same family.
How are they recognised?
The upper eyelid visibly droops and covers part of the pupil or iris
A tired, "heavy", or older appearance of the eyes
A feeling of pressure or heaviness on the eyelids
Narrowed visual field - especially above and to the sides
Unconscious raising of the eyebrows and furrowing of the forehead in an attempt to lift the eyelid
Blurred vision if the eyelid reaches the pupil
Sudden ptosis in one eye - especially if accompanied by double vision or a dilated pupil - requires urgent ophthalmological assessment, as it may be a sign of a neurological condition.
How are they treated?
The treatment of both conditions is surgical. In ptosis, surgery strengthens or shortens the muscle that lifts the eyelid. In dermatochalasis, excess skin is removed and, if necessary, the orbital septum is corrected.
The procedure is called blepharoplasty and is performed under local anaesthesia. Recovery is relatively fast and results are long-lasting.
What if they are left untreated?
In cosmetically pronounced forms without functional complaints, intervention is not medically necessary. When a drooping eyelid begins to encroach on the visual field, treatment becomes a medical indication - not just an aesthetic decision.
Without correction, long-term compensation (raising the eyebrows, tilting the head) can lead to neck pain and headaches.
Frequently asked questions
Does ptosis worsen with age?
Yes. Acquired ptosis - especially senile ptosis - usually progresses gradually with age as the eyelid muscle weakens. In dermatochalasis, excess skin also gradually increases over time. Intervention is therefore more often recommended when the condition begins to affect vision or daily activities.
Are there exercises or products that can lift the eyelid without surgery?
There is no proven effective conservative treatment that can permanently correct ptosis or dermatochalasis. Various products and exercises cannot replace surgical correction. In certain cases of neurologically-caused ptosis, medical therapy may be considered - but this is assessed by the doctor.
A drooping eyelid can be more than aesthetics.
Drooping eyelids sometimes narrow the visual field and require medical correction - schedule an examination and assess the condition.