Droopy eyes may be a naturally occurring feature in some people, creating a characteristic ‘sleepy eye’ look. However, in other cases, it can extend beyond just the cosmetic aspect and contribute to difficulty with vision, especially in cases of ptosis. The medical term, ptosis, refers to the drooping of the upper eyelids when it is markedly obvious and uncharacteristic for the person in question. Naturally droopy eyelids, that have been present from birth and do not hamper vision in any way, is not considered to be ptosis. Similarly ptosis should not be confused with angioedema, which is the swelling of the dermis of the skin due to an allergic reaction. Angioedema affects the dermis of the cheek and orbit thereby creating a swelling of the eyelid and not drooping.
In cases of ptosis, the drooping eyelids can obstruct the vision when looking upwards. If the eyelid droop is severe, it may even cause a visual obstruction when looking straight ahead. Looking downwards when engaged in tasks like reading may become a problem because the eyelids may droop even more when looking down. Headaches may occur if the forehead muscles are used to raise the eyebrows in an effort to raise the eyelids. Eye fatigue may also occur due to the effort needed to keep the eyes open. If ptosis occurs due to a nerve problem, the eyelid of only one side may droop and it may get worse with time. It may also be accompanied by diplopia or double vision. The head may have to be tilted back in an effort to see properly.
Causes of Droopy Eyes and Eyelids
There are various causes for droopy eyes, the most common being non-pathological like age and lifestyle factor. However muscle or nerve disorders, injury, and birth defects in newborns may cause droopy eyelid(s) , which is considered a sign of an underlying disorder.
Congenital (From Birth) Droopy Eyes
Congenital droopy eyes are at times seen in a newborn baby and may be due to underdevelopment of the levator muscle of the eye (the muscle that lifts the upper eyelids). It may be associated with strabismus (crossed/misaligned eye or squint). If left uncorrected, it can lead to amblyopia (poor vision development) or astigmatism (vision distortion). In cases where the eyelid covers the pupil, surgery is definitely indicated.
Droopy Eyes in Adulthood
Droopy eyes occurs more frequently in adults. There are various causes for the eye drooping and these conditions may also be present in children.
Age is one of the most common causes of droopy eyes and affects both sides, although it may be worse on one side. Aging causes stretching of the levator muscle of the eye and stretching and wrinkling of the skin around the eyes. This may be accompanied by fatty deposits beneath the skin, causing the upper eyelids to sag. It gives an indication of age and may make a person look older than their actual age. It also creates the impression of tiredness or sadness, sometimes referred to as ‘weepy eyes’. This condition prompts many patients to consider cosmetic surgery to lift the upper eyelid and accentuate the eyes.
Trauma to the eye such as a assault or an accidental injury to the eye may result in ptosis. Any injury to the oculomotor nerve which supplies the levator muscle can also cause drooping of the eyelids.
Occulopharyngeal muscular dystrophy is an inherited muscle disease which affects movement of the eyes and may also cause problems with swallowing. Ptosis may be one of the symptoms of this disease.
Another group of muscle diseases, called progressive external opthalmoplegia, occur more often in young adults and may cause bilateral ptosis (affecting both sides). There may be associated problems with eye movement and other symptoms include conditions with the muscles of the heart and throat.
Myasthenia gravis is a rare disease where there is weakness and fatigue of the voluntary muscles as a result of a communication problems between the muscles and nerves. The symptoms may increase by repeated use of the muscle and improve on rest. There is no cure for myasthenia gravis and medication may only help to relieve the symptoms. The eye muscles are affected in most cases, causing ptosis, diplopia (double vision) and blurred vision. Other muscles may be affected too, such as muscles of the face, throat, arms and legs, which may cause abnormal facial expressions and difficulty in speaking, swallowing or walking.
Brain injury or cranial nerve injuries due to any cause can cause ptosis by affecting the nerve supply to the muscles of the eyes and eyelids. Stroke, brain tumor, aneurysm, or long-term diabetes may also be involved.
Horner’s syndrome is a rare disorder that occurs due to damage of the sympathetic nerves (which control circulation and perspiration) supplying the face and eyes. The typical symptoms usually occur on one side and are ptosis (drooping of the upper eyelid), constricted pupil (decreased pupil size), and anhydrosis (absent or decreased sweating of the face) on the affected side.
Horner’s syndrome may occur as a result of stroke, tumor, or injury to the spinal cord, but in some cases no cause may be found. There is no definite treatment for Horner’s syndrome except treatment and management of the underlying cause.
Bell’ palsy is usually accompanied by a facial droop due to a one-sided (unilateral) partial or complete paralyis of the facial muscles. Refer to Facial Droop Causes for more information.
Multiple sclerosis is a condition that arises from degeneration of the fatty sheath surrounding the nerves. Ptosis may be a symptom along with muscle weakness and lack of coordination.
This is a type of connective tissue disease where the skin on the upper or lower eyelid loses its elasticity so that it hangs down in folds and gives the impression of droopy eyes. Dermatochalasis is usually associated with old age and there may be a genetic predisposition. Other conditions such as certain skin disorders, injury to the eye and surrounding tissues, thyroid disease or chronic renal disease may also be involved. It may cause problems with vision besides giving a tired look to the eyes and may also be a cause for cosmetic concern. Besides treating the underlying cause, the loose skin around the eyes may need to be surgically tightened or removed completely.
Local Eye Problems
- Tumor in the eye socket or of the eyelid
- Eyelid and surrounding tissues – infection (orbital cellulitis) or inflammation (blepharitis)
Systemic Conditions, Lifestyle & Induced Causes
- Long-term diabetes can affect the nerves supplying the eyes and eyelids and cause ptosis.
- Fatigue, lack of sleep and eye strain can lead to baggy eyes and baggy eyelids and give the impression of droopy eyes.
- Fluid retention and allergies, even if angioedema is not present, can also contribute to droopy eyes but does not cause ptosis.
- Previous eye surgery – ptosis may occur as a complication following cataract surgery.
- Over-exposure to the sun
- Alcohol abuse
- Poor nutrition
- Hereditary factors
- Facial palsy which may be accompanied by a facial droop.