As we age, wrinkles and droopy eyelids are to be expected. But, if an eyelid droops so much that it covers the pupil and blocks the vision, it can cause significant disruption in our lives. When eyelids fall to a lower position than normal, the condition is called ptosis, or blepharoptosis.
While typically a result of natural aging, ptosis can be a sign of a more serious neurological (nerve) or muscular disease, so it is imperative that a doctor be consulted when you first notice one or both of your eyelids drooping. This is particularly true if it seems to have appeared overnight.
This condition can strike anyone at any age and there is virtually no difference in prevalence between the sexes or ethnic groups. For some, the droop may be barely noticeable. But for others the eyelid may extend over the pupil, blocking vision.
Children can be affected by this condition, too, sometimes from birth. Regular eye examinations to ensure their vision isn’t impacted adversely for life are absolutely necessary.
For children and adults alike, there doesn’t seem to be a way to prevent this condition, but both conventional and natural treatments for ptosis can help. Both surgical and nonsurgical treatment options are available and the best plan must be tailored to each individual’s needs. It is important to have regular eye examinations and to address any underlying medical conditions that may be causing ptosis as maintaining good eye health is key to our quality of life.
What Is Ptosis?
Ptosis is a condition where one or both of the upper eyelids droop. The droop can be slight and barely noticeable, or it can be severe, blocking vision and your line of sight. The drooping occurs because the levator muscle — the muscle responsible for raising and lowering the eyelid — is compromised. There are six recognized types of ptosis: (1)
Aponeurotic Ptosis: This is the most common and is associated with aging. The levator muscle has become overstretched and simply doesn’t bounce back the way it once did. This may be caused by excessive eye rubbing or prolonged contact lens use.
Neurogenic Ptosis: This type occurs when the nerve pathways that control the movement of the eyelids are compromised. This can be due to Horner syndrome, third nerve palsy, or myasthenia gravis.
Myogenic Ptosis: Certain types of systemic disorders that cause muscle weakness, like muscular dystrophy, can cause this type of ptosis as the other muscles in the body continue to weaken, sometimes including the levator muscle.
Mechanical Ptosis: If the eyelid is weighed down by a mass or excessive skin, mechanical ptosis can occur.
Traumatic Ptosis: Ptosis can also be the result of an external injury or trauma to the eyelid or the eye. Wearing proper eye protection when playing sports and working with tools is essential for good eye health.
Congenital Ptosis: Children can be born with droopy eyelids. This occurs when the levator muscle doesn’t develop properly in the womb. Surgery is often recommended to ensure proper vision develops. Failure to treat can result in lazy eye and a lifetime of poor vision. Children with ptosis, even mild cases, should have examinations from an eye specialist annually. Through the early years, eyes change shape as they grow and ptosis can worsen.
Ptosis Signs & Symptoms
- Drooping eyelid that is noticeable when looking in the mirror
- Tilting of the head backwards to see under the lid
- Raising of the eyebrows to lift the eyelids for better vision
- Dry eyes
- Watery eyes
- Dull aching in and around the eyes
- Looking tired
Ptosis can look and present similarly to dermatochalasis, a connective tissue disorder that causes skin to hang in folds. It is most often associated with less-than-normal elastic tissue formation. If you notice drooping eyelids, speak to your ophthalmologist as soon as possible. (2)
Causes & Risk Factors
While most often caused by aging, there are a variety of underlying health conditions and other complications that can cause ptosis. (3)
- Injury or trauma
- Infection or tumor of the eyelid
- Tumor inside the eye socket
- Side effect of cataract surgery
- Side effect of corrective eye surgery, like LASIK, PRK, LASEK, RLE and others
- Levator muscle problems
- Eye tumor
- Myasthenia gravis, a rare and progressive muscle weakness disorder. Eyelid drooping is often a first sign of this condition.
- Muscle disease like muscular dystrophy
- Brain tumor
- Brain aneurysm
- Horner’s syndrome
- Cancer of the nerves
- Bell’s palsy
- Side effect of a Botox injection
Before a treatment plan can begin, a proper diagnosis is necessary. As there are many potentially dangerous underlying causes of ptosis, a physical examination, a discussion of your medical history, an extensive eye examination, blood tests, and possible CT scans and MRIs may be ordered. These tests can help to rule out neurological and muscle diseases like myasthenia gravis and certain autoimmune disorders.
In the eye examination, a slit lamp will be used and dilation of the affected eye or eyes may be required. In addition, your doctor may do a tension test by injecting the drug edrophonium (brand name: Tensilon) to determine muscle strength and response. Be prepared to talk about how long the eyelids have been drooping, if you can think of anything specific that caused it, and any other signs or symptoms you may be experiencing like headaches, muscle weakness, numbness, tingling as well as any changes in speech or swallowing. (4)
If an underlying condition, like diabetes, is determined to be the root cause of the ptosis, treating the condition will often occur before surgical options to correct the drooping eyelid are considered.
If the ptosis is severe, and the droopy eyelid is blocking or limiting vision, surgery may be required. The surgery is an outpatient procedure where the surgeon tightens the levator muscles to lift the eyelids. This improves both vision, and the appearance of the eyelid.
As with all surgical procedures, there are risks. After this surgery, the eyelids may appear asymmetrical, and in rare cases eyelid movement may be lost. Other rare complications include a scratched cornea and a hematoma. It is imperative that you select an ophthalmologist or a plastic surgeon with significant experience with correcting ptosis for best results. (5)
One of the more effective nonsurgical options is eyeglasses with an attached “crutch” that holds up the eyelid to allow for proper vision. An ophthalmologist attaches the crutches to the inside of the frames and they are rarely noticeable. They are considered effective and safe, but proper fitting may take some patience. It is possible that you may develop dry eyes because the crutches keep the eyelids open. Be sure to follow your eye doctor’s directions for keeping eyes lubricated properly. (6)
Ptosis: 8 Natural Ways to Manage Symptoms
1. Tea Bag Eye Compress.
To relieve the pain and discomfort associated with ptosis, soak chamomile tea bags in hot water and then allow them to come to room temperature. Squeeze out excess tea, lie down, place the bags on your eyes and relax. As tea can stain, be sure to put a towel down behind your head to catch any drops.
According to research from Case Western Reserve University, chamomile tea fights inflammation, calms nerves and is particularly helpful when fighting eye inflammation because of the various phytochemicals it contains. When applied topically, it is effective at helping to combat eye infections and certain disorders of the eye, including blocked tear ducts and other inflammatory conditions.
When enjoyed as a tea, this powerful flower shows anticancer activity, helps to fight a cold, soothes the gastrointestinal tract and, for those with diabetes, it helps to lower blood sugar levels. Enjoy a cup or two a day for best results. (7)
If the ptosis is caused by certain neuromuscular conditions like Bell’s palsy or as a result of a stroke, acupuncture may help. An acupuncturist with experience in neuromuscular conditions will place needles in certain facial and scalp muscles to help re-innervate muscles in the face and to stimulate atrophied muscles. You may need to visit your acupuncturist twice a week for a couple of months until the symptoms abate. (8)
3. Vitamin B12.
This essential nutrient is vital for neuromuscular function. If you are a vegetarian or a vegan, you are more likely to be deficient in vitamin B12. According to the National Institutes of Health (NIH), the RDA for vitamin B12 is 2.4 micrograms for adults. If you don’t eat fish or beef, taking a high-quality supplement can help to keep levels in the optimal range.
Increasing vitamin B12 in your diet is easy. Consume more wild-caught, cold-water fish like salmon, tuna and mackerel, as well as grass-fed beef and free-range chicken. My hearty beef stew is a perfect comfort food for a cool evening, while my recipe for pecan pesto salmon is great for a quick healthy weeknight meal.
4. Netrapana Therapy.
Ayurvedic Medicine dates back thousands of years and is based on balancing diet, lifestyle and herbal remedies to treat a wide range of conditions. The standard treatment for ptosis is a combination of warmed ghee, salt and certain oils poured carefully over the eyes by an Ayurvedic medicine professional. Not only is this practice soothing, it actually can strengthen the nerves and muscles of the eyes. Find a practitioner in your area and ask if they have experience in netrapana therapy. (9)
5. Eyelid Strengthening Exercises.
When ptosis is caused by aging or diminished muscular strength, exercising the eyelids may help to improve the appearance and lessen the droopiness. For the first exercise, shut both eyes and place a finger at the base of the eyelid and try to open your eyes, raising your eyebrows as high as possible. Do 10–15 repetitions.
The second eyelid-strengthening exercise requires you to be in front of a mirror. Place your index fingers just below your eyebrows and then raise them up against the brow bone, and then close your eyes. Blink five to seven times and then squeeze your eyes tightly together for five seconds. Repeat the entire exercise 10 times each day. (10)
6. Eat Eye-friendly Foods.
Beta carotene and other carotenoids are associated with good eye health. In addition, for those with ptosis, foods rich in beta carotene have anti-inflammatory properties, protect against certain types of cancer, boost immune system response, and help to protect the skin from damage. When designing meals, be sure to include a serving (or two!) of beta carotene-rich foods.
They are easily identified as they are brightly colored, and taste grate. Look for fruits and vegetables with bright yellow, orange or red flesh, like red bell peppers, papaya, sweet potatoes, winter squash, and tomatoes. Try this crunchy and satisfying carrot apple salad that complements any number of main dishes.
Just six milligrams each day of lutein, along with a healthy lifestyle and diet containing foods rich in antioxidants and fatty acids has been shown to lower the risk of age-related macular degeneration by an average of 43 percent, and may help to protect against cataracts, according research from Harvard Medical School published in The American Journal of Clinical Nutrition. (11)
Lutein is a powerful carotenoid and the best source, hands down, is kale. Other leafy greens contain lutein, too. But cup for cup, kale contains more than twice the lutein of turnip greens, collard greens or spinach. You can make a healthy and nutrient-dense snack with baked kale chips and some hummus.
8. Avoid Eyestrain.
Eyestrain is a real problem in today’s world. We spend so much time looking at computer or phone screens, focusing on one distance (with abnormal light), that we strain our eyes. When looking at an electrical device, it is important to look away from the screen, blink and refocus on something 10 feet or so away, every 10 minutes for 30 seconds.
If eyelids droop unexpectedly, or are accompanied by any one or more of the following symptoms, seek emergency medical attention immediately.
- Migraine headache
- Muscle weakness in face, arms or legs
- Double vision
- Difficulty swallowing
- Eye infection
- Bulging eye
- Pain in the eye or eye socket
Ptosis Key Points
- Drooping eyelids, or ptosis, is normally caused by aging; however, if it develops quickly see a doctor immediately as it may be a sign of a serious health condition.
- Ptosis can be caused by a stroke, certain types of cancer, a brain tumor or aneurysm, diabetes and rare muscle diseases.
- Ptosis can affect one eye or both eyes and in some cases the drooping may be so severe that it adversely impacts vision.
- Children can be born with ptosis at birth; failure to treat it can lead to a lifetime of poor vision.
- Conventional treatments include both surgical and nonsurgical options
8 Natural Ptosis Treatments
- Use chamomile tea bag compresses and drink chamomile tea to reduce inflammation and ease symptoms.
- Acupuncture may be effective if the root cause is neuromuscular.
- Vitamin B12 is essential for healthy neuromuscular function.
- Netrapana therapy, an Ayurevedic practice of pouring warm ghee, salt and oils over the eyes, can strengthen muscles and nerves.
- Do eyelid strengthening exercises daily.
- Eat beta carotene-rich foods.
- Eat lutein-rich foods.
- Avoid eyestrain.