What Are Droopy Eyelids?
Droopy eyelids—medically known as ptosis—occur when the upper eyelid sags lower than normal. It may affect one or both eyes and range from mild to severe, sometimes covering part of the pupil and impairing vision. While ptosis can occur at any age, it is especially common as people grow older due to muscle weakening and changes in eyelid structure. Beyond its impact on vision, droopy eyelids can also affect appearance and self-confidence.
Common Causes of Ptosis
Age-Related Ptosis
The most common cause of droopy eyelids is the natural aging process. Over time, the levator muscle—responsible for lifting the eyelid—can stretch or weaken, leading to a sagging eyelid.
Congenital Ptosis
Some individuals are born with droopy eyelids due to underdeveloped or dysfunctional levator muscles. This type of ptosis often becomes more noticeable during childhood and can affect eye development and alignment if left untreated.
Neurological and Muscular Causes
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Nerve damage (e.g., third cranial nerve palsy)
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Myasthenia gravis, an autoimmune condition that affects muscle strength
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Horner’s syndrome, a neurological disorder affecting facial muscles
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Stroke or trauma to the brain
Mechanical or Structural Ptosis
This occurs when excess skin or fatty tissue weighs down the eyelid. It can also be caused by:
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Eyelid tumors
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Swelling or scarring from past surgeries
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Long-term contact lens use (especially hard lenses)
Traumatic Ptosis
Injury to the eyelid or surrounding muscles can damage the lifting mechanism of the eyelid, leading to acquired ptosis.
Symptoms and Complications
While the most visible symptom is a visibly drooping eyelid, ptosis can cause a range of other issues:
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Obstructed or narrowed field of vision
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Eye strain or fatigue, especially when trying to keep the eyes open
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Headache from compensatory brow-lifting
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Asymmetrical appearance of the eyes or face
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Impaired reading or driving ability
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Dry or irritated eyes due to incomplete blinking
In children, uncorrected ptosis can result in amblyopia (lazy eye) or poor visual development.
Diagnosis and Evaluation at Bangkok Eye Hospital
Proper diagnosis is essential to determine the underlying cause of ptosis and decide the best treatment plan. At Bangkok Eye Hospital, our ophthalmologists and oculoplastic specialists perform comprehensive evaluations that may include:
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Visual acuity test
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Slit-lamp examination
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Eyelid position measurement
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Levator function testing
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Visual field testing (especially for moderate to severe ptosis)
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Neurological examination if nerve or muscle involvement is suspected
If necessary, imaging such as MRI or CT scans may be used to rule out deeper causes such as tumors or nerve compression.
Treatment Options for Droopy Eyelids
Surgical Correction
Surgery is the most effective and long-term solution for moderate to severe ptosis, especially when vision is affected or the cosmetic impact is significant.
Types of Eyelid Surgery Offered:
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Levator Advancement or Resection
Tightens or shortens the levator muscle to improve eyelid lift. Most common approach for age-related and acquired ptosis. -
Frontalis Suspension Surgery
Connects the eyelid to the forehead muscle (frontalis) using a sling, allowing patients to use their forehead to lift the eyelid. Often used in congenital ptosis with poor levator function. -
Blepharoplasty
Removes excess skin and fat from the upper eyelids, often performed alongside ptosis repair to enhance both vision and appearance.
Nonsurgical Approaches
While surgery is often necessary, some mild cases or patients with specific health concerns may benefit from alternative treatments:
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Ptosis crutch – A small device attached to glasses to mechanically lift the eyelid.
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Botulinum toxin (Botox) – Can be used in certain cases to balance eyelid function or treat underlying muscle imbalance.
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Treating the underlying condition – For example, in cases related to myasthenia gravis or nerve disorders, managing the root cause may improve ptosis symptoms.
Recovery and Post-Surgical Care
Surgery for ptosis is typically an outpatient procedure performed under local anesthesia with sedation. Recovery is generally quick, and patients can resume daily activities within a few days.
Postoperative care includes:
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Use of antibiotic and anti-inflammatory eye drops
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Cold compresses to reduce swelling
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Avoiding strenuous activities or rubbing the eyes for several days
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Follow-up visits to monitor healing and eyelid function
In most cases, both vision and cosmetic appearance are significantly improved after surgery.
Related Services at Bangkok Eye Hospital
We offer a full spectrum of services tailored for patients with ptosis and other eyelid disorders:
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Oculoplastic Surgery Clinic
Specialized in cosmetic and reconstructive eyelid surgeries performed by certified ophthalmic plastic surgeons. -
Facial Aesthetic Eye Services
Combines medical and aesthetic techniques to restore eyelid function while improving appearance. -
Children’s Eye Center
For diagnosis and management of congenital ptosis in pediatric patients. -
Visual Field Testing Center
To assess visual impairment related to eyelid drooping. -
Comprehensive Eye Examination Clinic
Ideal for aging adults to screen for common age-related eye conditions, including ptosis and cataracts.
Frequently Asked Questions (FAQs)
Is droopy eyelid surgery covered by insurance?
Yes, if the condition affects your vision or daily function. Bangkok Eye Hospital can assist with the medical documentation required for insurance claims.
Is ptosis surgery painful?
The surgery is performed under local anesthesia, and most patients report only mild discomfort during recovery, which can be managed with pain relief.
Will I have a scar after ptosis surgery?
Scarring is minimal and typically hidden in the natural crease of the eyelid. With proper care, it usually becomes barely visible over time.
How long is recovery from droopy eyelid surgery?
Initial swelling may last 1–2 weeks, but most patients resume normal activities within a few days. Full results are typically seen within 4–6 weeks.
Can ptosis come back after surgery?
While recurrence is rare, it can happen, especially if the underlying muscle continues to weaken. Follow-up care is essential.
Is ptosis only a cosmetic issue?
No. While it does affect appearance, moderate to severe ptosis can impair vision, especially in older adults or when both eyes are affected.
