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Eyelid drooping
Last reviewed: 05.07.2025

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Sometimes you can see a difference in the appearance of the eye slits in people, when one eyelid seems to be lowered. This pathology is called ptosis and occurs in both children and adults. Often, ptosis appears gradually and progresses over time due to various reasons.
Normally, the edge of the upper eyelid should overlap the iris by approximately 1.5 mm. If it overlaps more than 2 mm, or covers the pupil, we have to talk about pathology.
Causes of drooping eyelids
The muscle that lifts the upper eyelid works to open the eye and is located in the upper eyelid under the fat layer. This muscle is attached on opposite sides to the tarsal cartilage and to the skin of the upper eyelid. The causes of drooping eyelids are most often associated with this muscle.
The main causes of pathology:
- a congenital disease associated with insufficient development of the muscle designed to lift the upper eyelid;
- trauma to the muscle that lifts the upper eyelid, or trauma to the oculomotor nerve;
- stretching of the tendon of the muscle that lifts the upper eyelid (occurs in old age);
- paralysis of the cervical sympathetic nerve with the formation of Horner's syndrome;
- diabetes mellitus;
- stroke;
- tumor process in the brain.
If sudden signs of pathology appear, you should consult a doctor and undergo the prescribed diagnostic procedures.
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Drooping eyelid after botox
The Botox eyelid procedure is performed to smooth out visible wrinkles around the eyes. As a rule, this method is used in cases where cosmetics no longer help and there is a need for more effective measures. Lifting with Botox is one of such procedures.
Before giving Botox injections, the specialist should examine the eyelids and determine the areas of muscle hyperactivity. If injections are given in these areas, the muscles around the eyes will relax a little and the wrinkles will disappear.
However, sometimes after such a procedure a number of complications develop, including drooping of the eyelid. This condition can occur if the specialist who performs the procedure is not qualified enough. If Botox is administered incorrectly or the injection dosage is exceeded, the muscle that lifts the upper eyelid may lose strength and cease to perform its purpose.
According to statistics, drooping of the eyelid after Botox procedures occurs in 20% of complicated cases, but almost always this is due to an unqualified approach to performing this technique.
Drooping of the eyelid after Botox is unpleasant, but fortunately it cannot be considered a serious pathology, since without additional therapy the signs of drooping completely disappear within 3-4 weeks after the injection of the drug.
By the way, if you suffered from drooping eyelids before the procedure, Botox can only aggravate the disease. Clinicians do not always warn about this, so think about whether it is worth the risk.
Drooping of the upper eyelid
A condition such as drooping of the upper eyelid can create interference and limit visibility due to narrowing of the palpebral fissure. For this reason, drooping is considered an ophthalmological pathology that can provoke a violation of the function of the visual organs. The difference in visibility is especially noticeable if the drooping is unilateral. This condition cannot be ignored, and you should see an ophthalmologist or neurologist.
What symptoms should you be wary of and consider visiting a doctor?
- difficulty blinking and difficulty closing the eye completely;
- increased sensitivity of the eyes due to their incomplete closure;
- constant eye fatigue;
- deterioration of visual functions, appearance of double vision;
- it is possible to automatically throw the head back and tense the frontal muscles to facilitate opening the eyes and raising the eyelids;
- the appearance of strabismus and decreased visual acuity.
The upper eyelid may move with some difficulty or not move at all. Sometimes the pathology may be combined with a malfunction of the muscle responsible for the upward movement of the eyeball: in such cases, this function is impaired.
With dysfunction of the muscle that lifts the upper eyelid, the eyebrows may be raised and the head thrown back - forced positions to improve visibility of the eyes. The fold on the upper eyelid is sometimes present on the side of the drooping, or is located significantly higher.
Occasionally, more complex symptoms are observed:
- myasthenia, which is expressed by the development of strabismus and double vision. Symptoms increase in the second half of the day and may be accompanied by weakness and a feeling of fatigue;
- myopathy, which also includes double vision, drooping of both eyelids, while the performance of the muscle that lifts the eyelid is weakened, but present;
- palpebromandibular synkinesis - involuntary associated movements accompanying chewing, abduction and opening of the lower jaw. For example, when opening the mouth, the drooping may suddenly disappear, and after closing the mouth, it will be restored;
- the appearance of palpebral syndrome, which is characterized by a combination of drooping of the upper eyelid with eversion of the lower eyelid, as well as shortening of the palpebral fissure and other manifestations;
- the appearance of Bernard Horner syndrome, which is expressed by a combination of drooping eyelids, constriction of the pupil and sunken eyeball. Sometimes the pathology is detected against the background of increased sweating on the face and incomplete paralysis of the brachial nerves on the affected side.
The extent of the drooping of the upper eyelid directly affects the degree of visual impairment: either a slight decrease in vision or complete loss may be observed.
Drooping of the lower eyelid
When the edge of the lower eyelid is lowered below the border of the iris so much that the white part of the eye can be seen, we have to talk about drooping of the lower eyelid. This aesthetic defect occurs due to weakness of the lower eyelid, which can also appear after plastic surgery of the face and removal of excess skin. Such a defect is difficult to correct. Often, this requires surgical lifting or skin grafting on the lower eyelid. Unfortunately, transplanted skin often differs from the native skin, so the effect obtained does not always satisfy patients.
Lower eyelid drooping may be observed after surgeries or injuries. In addition to external aesthetic moments, there are also additional signs of pathology, for example, loss of the ability to completely close the eye. Lower eyelid drooping may be an independent symptom, or combined with protrusion of the eyeball, which can aggravate the pathology.
Drooping can be observed when looking directly at objects, can develop against the background of a visible lag in the function of the upper eyelid when looking down, or can imitate amazement and fear in the eyes when focusing the gaze.
Patients with drooping lower eyelids usually look tired and much older than their age.
Diagnosis of ptosis
The initial stage of diagnosing ptosis includes collecting anamnestic data, which clarifies the possibility of inheritance of the pathology, facts of injuries and surgical interventions in the facial area.
During external examination, attention is paid to:
- the position of the upper eyelid in relation to the iris;
- width of the palpebral fissure;
- differences in the position of the eyelids on the right and left eyes;
- maximum amplitude of upper eyelid movements;
- the location of the fold of the upper eyelid;
- the ability to move eyebrows and eyeballs;
- position of the neck.
If the doctor suspects damage to the ciliary muscle, an adrenaline test is performed: a tampon with adrenaline is placed on the muscle under the upper eyelid. An examination is performed after five minutes. If the affected upper eyelid is raised to the level of the opposite healthy eyelid, the test is assessed as positive.
Next, the condition of the visual organs is examined using tables, and microscopic examinations of the lacrimal layer, conjunctiva, and corneal tissue are carried out.
There is no need for laboratory tests for drooping eyelids. If a brain injury or pathology is suspected, an X-ray or magnetic resonance imaging or computed tomography procedure is prescribed.
Sometimes an ophthalmologist may need to consult a neurologist and surgeon.
Who to contact?
Treatment of drooping eyelid
Conservative methods of treating drooping eyelids are rarely used. Such methods can treat diseases of neurogenic etiology, as well as temporarily support the eyelid until surgical intervention is possible.
However, the overwhelming majority of eyelid drooping pathologies are treated surgically. Children can undergo such an operation from the age of 3: this should be done as soon as possible to prevent functional vision impairment and the development of strabismus. In order to eliminate a cosmetic defect (when vision is not impaired), the operation is performed after puberty, when the facial bone skeleton is already fully formed.
If prolapse is caused by trauma, the operation can be performed directly during the initial treatment of the wound surface by the surgeon, or after healing, that is, after 6-12 months.
In other situations, the doctor makes a decision about the timing of the operation depending on the specific case.
How is surgery performed for acquired eyelid ptosis:
- The surgeon removes part of the skin of the upper eyelid.
- Cuts the membrane that covers the entrance to the eye socket.
- Cuts the levator muscular aponeurosis.
- Removes part of the aponeurosis and sutures it below.
- Places a cosmetic suture on the wound.
How is surgery performed for congenital drooping of the upper eyelid:
- The surgeon removes part of the skin of the upper eyelid.
- Cuts the membrane that covers the entrance to the eye socket.
- Identifies the levator muscle.
- Shortens the levator by applying sutures.
- Places a cosmetic suture on the wound.
In case of significant congenital ptosis, the levator muscle, which lifts the upper eyelid, is sewn to the cranial vault muscle. In this way, the eyelid can be raised by tension of the forehead muscles.
At the end of the operation, the doctor applies an occlusive dressing, which is usually removed after a few hours.
This type of intervention is performed under general or local anesthesia. The duration of the operation is about 60 minutes.
The stitches can be removed on the 5th-6th day. The patient usually returns to normal life in 1-2 weeks, after the signs of swelling and hematoma have disappeared.
Often after surgery, doctors prescribe drug therapy to prevent possible complications. Such treatment involves prescribing the following medications:
- antiseptic agents (boric acid 2% or zinc sulfate 0.25% for rinsing 3 times a day for 1-2 weeks);
- antibiotic therapy (ofloxacin, gentamicin – antibacterial eye drops, one drop in the operated eye three times a day for a week);
- application of eye ointments with erythromycin, tetracycline, rolitetracycline (up to 2 times a day for 10 days).
It is important to pay attention to some existing contraindications to surgery for drooping upper eyelid. Blepharoplasty is not performed in the following cases:
- in case of exacerbation of chronic pathologies;
- in case of severe weakness of the immune system;
- for neuropsychiatric disorders;
- until the child reaches 3 years of age.
Prevention of drooping eyelids
An important point in the prevention of drooping eyelids is the timely treatment of any diseases that can provoke this pathology. For example, neuritis of the facial nerves must be promptly treated by a neurologist, and the possibility of drooping eyelids after Botox injections should be discussed with a lifting specialist.
If you notice weakness of the eyelids associated with age-related changes, then cosmetic and folk remedies can help you.
The easiest way is to use a lifting cream. You will be advised which cream to choose in a beauty salon or store. However, if you are prone to allergies, choose products with a hypoallergenic composition.
Traditional methods of prevention include the use of firming masks, oils and massage procedures.
To prepare the mask, take a beaten egg yolk and drop a couple of drops of sesame oil into it. The mask should be spread over the eyelids, left on, and then washed off with warm water after 20 minutes.
A mask made from grated potatoes also helps: wash the potatoes, grate them, put them in a cold place for a quarter of an hour, then spread the mask over the upper eyelids. Then it is recommended to lie down for about 20 minutes. Rinse off the mask and blot your eyes with a napkin.
It is said that using such procedures strengthens the eyelids and also eliminates fine wrinkles around the eyes.
Massage of the skin of the eyelids should be performed with the eyelids lowered. Before the procedure, the eyelids can be wiped with lotion to remove sebaceous scales and open the sebaceous gland ducts. Massage with a cotton swab or disk soaked in an antiseptic solution or ointment: 1% synthomycin solution, sodium sulfacyl solution, 1% tetracycline ointment, etc. Use stroking with light pressure, making circular and linear movements, moving from the inner corner of the eye to the outer corner. You can lightly tap the eyelids with your fingertips. Massage is practiced every day for 10-15 days.
Special gymnastics for eyes with weak muscles.
Starting position: standing.
- Look upwards without lifting your head, then sharply downwards. Repeat the movements 6 to 8 times.
- Look up and to the right, then diagonally down and to the left. Repeat the movements 6 to 8 times.
- Look up and to the left, then down and to the right. Repeat the movements 6 to 8 times.
- Look as far to the left as possible, then as far to the right as possible. Repeat the movements 6 to 8 times.
- We stretch our hand forward, hold it straight. We look at the tip of the index finger and gradually bring it closer, without stopping looking until the picture begins to "double". We repeat the movements 6 to 8 times.
- Place your index finger on the bridge of your nose. Look at your finger alternately with your right and left eyes. Repeat up to 12 times.
- Move your eyes in a circle to the right and left. Repeat the movements 6 to 8 times.
- Blink quickly for 15 seconds. Do 4 such approaches.
- Close your eyes tightly for 5 seconds, then open them sharply for 5 seconds. Repeat 10 times.
- Close your eyes and massage your eyelids with your finger in a circle for 1 minute.
- We move our gaze from the nearest point to the farthest one and vice versa.
Eyeball movements during exercises should be as wide as possible, but not painful. The movement tempo can be complicated over time. The duration of such prevention is at least 3 months.
Prognosis of drooping eyelid
If treatment for drooping eyelids was performed on a child, specialists recommend continuing to monitor the condition of the eyelids throughout the entire period of the child's growth.
After treatment the prognosis is favorable.
If ptosis is combined with paralysis of the eye muscles, the effectiveness of treatment may be partial.
Advanced conditions of neuromuscular pathology do not guarantee the achievement of a positive result.
Despite possible assurances of some specialists, the best treatment for drooping eyelids is currently considered to be surgical intervention. There are quite a lot of clinics that treat drooping eyelids. The main thing is to choose a good qualified doctor who will rid you of this defect.