Droopy eyes refers to drooping of an upper eyelid of one or both eyes. The droop may be barely noticeable, or the lid can descend over the entire pupil. Droopy eyelids can affect both children and adults. In children, it usually occurs before birth, but in adults, the condition usually occurs because of aging. If excess skin of the upper eyelids hangs down to cause visual problems, the condition is called dermatochalasis. If the eyelid itself falls, the condition is called ptosis.
Ptosis is an abnormally low position (drooping) of the upper eyelid and occurs when the muscles that raise the eyelid (levator and Muller’s muscles) are not strong enough to do so properly. It can affect one eye or both eyes and is more common in the elderly, as muscles in the eyelids may begin to deteriorate. The drooping may also be worse after being awake longer, when the eyelid muscles are tired. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. Ptosis can also be congenital, and results from an abnormal formation of the muscle. This leaves the eyelid without normal lifting power.
The workup for ptosis involves taking eyelid photographs, obtaining measurements of the eyelid position, and a visual field test to determine how much peripheral vision is affected by ptosis. Most insurance companies require this information to qualify the condition for payment. Occasionally, other testing may be required if other medical conditions are being considered as a cause for ptosis.
If an underlying medical condition causing ptosis is found, the treatment will be specific to that disease. Most cases of ptosis are associated with aging and there is no disease involved. Surgery can be done to improve the appearance of the eyelids in milder cases if the patient wants it. In more severe cases, surgery may be necessary to correct interference with vision. In children with ptosis, surgery may be necessary to prevent amblyopia (lazy eye). Surgical treatment for children may involve surgery directly on the muscle, or by attaching the eyelid to the eyebrow (frontalis suspension).