A drooping eyelid (ptosis) means the upper eyelid sits lower than normal. It can be one-sided or affect both eyes, and while mild cases may mainly concern appearance, pronounced drooping can limit the visual field. Causes vary and determine the appropriate specialist referral and work-up.
Ptosis refers to an abnormally low position of the upper eyelid. It may be present from birth (congenital) or develop later. Severity ranges from barely noticeable to significant drooping that interferes with reading and daily activities.
Many mechanisms can cause ptosis: congenital structural differences; age-related weakening of eyelid muscles and support tissues; myogenic causes (muscle disorders); neurogenic causes (for example third cranial nerve palsy or Horner syndrome); mechanical factors such as scarring, masses or swelling; trauma; and associations with systemic illnesses. Identifying the underlying mechanism guides further tests and referrals.
Initial assessment is typically by an ophthalmologist. The exam checks eyelid position and levator muscle function, eye movements, pupil responses and visual acuity. If neurological signs are present—sudden onset, pupil changes, double vision—a neurologist may be involved. Oculoplastic surgeons or orbital specialists help with structural or surgical considerations. Imaging and laboratory tests may be ordered when a neurological cause or mass is suspected.
Seek immediate medical attention if the drooping starts suddenly or is accompanied by warning signs such as sudden vision loss, severe eye pain, new double vision, facial weakness, slurred speech, fainting, or a sudden severe headache. These features may indicate a neurological emergency and require prompt evaluation at an emergency department.
Clinicians will document the onset and progression, measure eyelid position and levator function, assess pupils and eye movements, and test vision. Photographs and visual field testing may be used. If a neurologic cause is suspected, imaging (CT or MRI) or targeted blood tests may follow. This assessment determines whether observation, further tests, or referral is needed.
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