Ptosis (pronounced “toe-sis”) is a drooping of the upper eyelid. It is most often caused by age-related stretching of the muscle that lifts the lid, and can affect one or both eyes. When the lid droops far enough it blocks the upper part of your vision, causes eye strain and a constant need to lift your brow or tilt your head back. The treatment is a short day-case operation — usually under local anaesthetic — that tightens the lifting muscle and restores the eyelid to its natural height, from £3,100 per eyelid.
What is ptosis?
The upper eyelid is held open by the levator muscle and its tendon. In ptosis, this lifting mechanism weakens, stretches or detaches, so the lid sits lower than normal. The most common form in adults is aponeurotic ptosis — an age-related loosening of the levator tendon — but ptosis can also be present from birth (congenital) or arise from nerve, muscle or mechanical problems.
Ptosis is different from the excess upper-lid skin treated by a blepharoplasty, although the two often occur together and can be corrected at the same time. Our guide on the difference between blepharoplasty and ptosis surgery explains which procedure does what.
Symptoms of ptosis
The effects of ptosis depend on how low the eyelid sits:
- A visibly drooping upper eyelid, on one or both sides
- Reduced vision, especially loss of the upper field, when the lid covers part of the pupil
- Tired, aching eyes from the effort of keeping them open
- Raised eyebrows or a furrowed forehead as you unconsciously lift the lid with your brow
- Tilting the head back or lifting the lid with a finger to see clearly
A sudden, new droop — particularly with double vision, a different-sized pupil or weakness elsewhere — needs urgent assessment, as it can point to a neurological cause.
A drooping lid affecting your vision? An oculoplastic assessment measures the lid and lifting muscle to plan the right correction.
Book an eyelid assessmentCauses & risk factors
Ptosis has several causes, which guide the type of surgery needed:
- Ageing (aponeurotic) — stretching or detachment of the levator tendon; the most common adult cause
- Congenital — a weak levator muscle present from birth
- Neurological — conditions such as a third-nerve palsy, Horner’s syndrome or myasthenia gravis
- Mechanical — a lump or extra weight on the eyelid pulling it down
- Long-term contact lens wear, eye injury or previous eye surgery
How ptosis is diagnosed
An oculoplastic surgeon assesses the eyelids carefully and checks for any underlying cause:
- Margin reflex distance — measures how far the lid covers the pupil to grade the droop.
- Levator function test — measures how well the lifting muscle works, which determines the surgical technique.
- Palpebral fissure measurement — records the height of the eye opening.
- Eye and pupil examination — checks for neurological signs such as double vision or unequal pupils.
- Tests for underlying conditions — such as myasthenia gravis, where the cause is suspected to be muscular.
Treatment options
Surgery is the definitive treatment for true ptosis, and the technique is chosen to match the cause — see our ptosis treatment overview for full detail.
- Levator advancement or resection — the most common operation; the lifting muscle is tightened or re-attached through a hidden skin-crease incision to raise the lid.
- Müller muscle resection — an option for mild ptosis with good muscle function, often done from the inner surface of the lid.
- Frontalis sling — used when the levator muscle is very weak (often in congenital ptosis), linking the lid to the brow muscle so a brow lift raises the lid.
- Combined surgery — ptosis correction can be performed together with a blepharoplasty where excess skin is also present.