A drooping upper eyelid, medically known as ptosis, occurs when the upper eyelid sags or falls. While ptosis can affect one or both eyes, this article will focus on unilateral, or one-sided, drooping. This common concern can impact vision and appearance, often leading individuals to seek medical advice.
What Causes One Eyelid to Droop
The most frequent reason for unilateral eyelid drooping in adults is age-related changes, often due to the stretching or weakening of the levator muscle tendon over time. This condition is known as aponeurotic ptosis.
Nerve damage can also cause one eyelid to droop by affecting the nerves that control eyelid movement. Examples include Horner’s syndrome, which can be caused by serious conditions like a lung tumor or carotid artery dissection, and third cranial nerve palsy. Muscle disorders, such as myasthenia gravis, may cause general muscle weakness that includes the eyelids, often presenting as fluctuating drooping that worsens with fatigue. Trauma to the eye or eyelid can directly injure the supporting structures, leading to ptosis.
Some individuals are born with a drooping eyelid, a condition called congenital ptosis, which results from an underdeveloped levator muscle. Other, less common medical conditions like tumors, inflammation, or even previous eye surgery can also contribute to unilateral eyelid drooping.
Non-Surgical Ways to Address Drooping Eyelids
Oxymetazoline hydrochloride ophthalmic solution 0.1%, marketed as Upneeq, is an FDA-approved prescription eye drop. This solution works by stimulating Müller’s muscle, one of the muscles responsible for eyelid elevation, causing it to contract and temporarily lift the eyelid by about 1-2 millimeters. The effects typically begin within 15 minutes and can last for approximately 6 to 8 hours, making it suitable for mild to moderate cases.
Another non-surgical approach involves “ptosis crutches,” which are specialized attachments that can be installed onto eyeglasses. These crutches are designed to physically support and hold the drooping eyelid in a more elevated position, improving visibility. They can be a viable option for individuals who are not surgical candidates or prefer a non-invasive solution.
If the eyelid drooping is a symptom of an underlying medical condition, such as myasthenia gravis, managing that condition with appropriate medication can often improve the ptosis. However, unproven remedies like “eyelid exercises” are generally not effective for true anatomical or neurological ptosis and should not be relied upon as a substitute for professional medical evaluation.
Surgical Solutions for Eyelid Drooping
Surgery is often the most effective and lasting solution for persistent or significant eyelid drooping. The specific surgical procedure chosen depends on the underlying cause, the severity of the ptosis, and the remaining function of the levator muscle.
Levator resection, or levator aponeurosis advancement, is a common procedure where the levator muscle is shortened or tightened to lift the eyelid. This technique is frequently used for age-related or congenital ptosis, especially when the levator muscle still has some function. The surgeon makes an incision in the natural skin crease of the eyelid, repositions the muscle, and secures it with stitches to achieve the desired eyelid height and contour.
For more severe ptosis, particularly when the levator muscle has very poor function, a frontalis sling procedure may be performed. In this surgery, the eyelid is connected to the eyebrow (frontalis) muscle using a sling material, allowing the eyebrow’s movement to lift the eyelid. Materials for the sling can include sutures, artificial strips, or even the patient’s own tissue.
Müller’s muscle conjunctival resection is a less invasive option for mild ptosis. This procedure involves removing a small portion of Müller’s muscle and the conjunctiva from the inside of the eyelid. It is often considered when a topical phenylephrine test shows that the eyelid can be temporarily lifted. General considerations for these surgeries include local or general anesthesia, a recovery period involving bruising and swelling, and potential risks such as under-correction, over-correction, or asymmetry.
When to Seek Professional Medical Advice
While some cases of eyelid drooping develop gradually and are not immediate emergencies, certain symptoms warrant prompt medical attention. If eyelid drooping appears suddenly, especially over hours or days, it could signal a serious neurological issue. This is particularly concerning if it is accompanied by other symptoms like double vision, severe headache, eye pain, changes in pupil size or shape, or weakness or numbness in other parts of the face or body. These combined symptoms could indicate conditions such as a stroke, aneurysm, or other neurological emergencies.
Even if not an emergency, any persistent or concerning eyelid drooping should prompt a consultation with a medical specialist. An ophthalmologist, oculoplastic surgeon, or neurologist can accurately diagnose the cause and determine the most appropriate treatment plan, ruling out any serious underlying health issues.