Ptosis Types: Causes and Treatment Guidelines for Each Types

Ptosis is a drooping upper eyelid caused by a weak or stretched eyelid-lifting muscle, called the levator. The two main types are congenital ptosis, present from birth, and aponeurotic ptosis, which comes with age. Treatment depends on the type, how far the lid droops and how well the muscle works. Surgery is the main treatment when vision or appearance is affected.

By Assoc. Prof. Dr. Preamjit Saonanon, oculoplastic ophthalmologist · Updated September 2026

What is ptosis?

In ptosis, the upper eyelid sits lower than normal, often at or over the edge of the pupil. People may raise their eyebrows or tilt their head back to see, which can cause forehead lines and neck strain. Ptosis is different from loose eyelid skin (dermatochalasis), where the muscle still works normally.

What are the symptoms of ptosis?

• One or both upper eyelids droop, sometimes covering the pupil

• Reduced upper field of vision

• Tired, heavy eyes and frequent eyebrow raising

• In children, holding the head tilted back

What are the types of ptosis?

Congenital ptosis

This is present at birth or appears in the first year, when the levator muscle does not develop normally. If the lid covers the pupil, it can block visual development and cause amblyopia (lazy eye), so children need an early eye examination.

Aponeurotic ptosis

This is the most common type in adults and older people. The tendon of the levator muscle stretches or loosens with age, and also after long-term contact lens wear, frequent eye rubbing or earlier eye surgery.

Other types

Ptosis can also follow an injury (traumatic), a mass weighing the lid down (mechanical), muscle diseases (myogenic) or nerve problems (neurogenic). Read about ptosis in the elderly.

How is congenital ptosis treated?

Mild cases that do not affect vision can be watched with regular eye checks, and any lazy eye is treated with glasses or patching. When vision or appearance is affected, surgery may shorten the levator muscle (levator resection) when muscle function is moderate, about 4–8 mm. When the muscle is very weak, a frontalis sling lets the forehead muscle lift the lid.

How is aponeurotic ptosis treated?

Mild ptosis that does not affect vision can be observed. When the droop affects vision or daily life, ptosis surgery repairs and tightens the levator tendon, usually through an incision in the eyelid crease. Excess skin can be removed at the same time with blepharoplasty.

Surgery has risks, such as uneven eyelids, over- or under-correction and dry eyes, and results vary from person to person.

When should I see a doctor urgently?

Get prompt medical care if ptosis appears suddenly, gets worse as the day goes on, or comes with double vision, headache, a larger pupil or eye pain. These can be signs of a nerve or muscle disease.

Frequently asked questions

Can ptosis be caused by other diseases?

Yes. Myasthenia gravis, third nerve palsy, Horner's syndrome and some nerve or muscle diseases can cause ptosis, so a proper eye examination is important.

Can ptosis affect only one eye?

Yes. Ptosis in one eye is called unilateral ptosis and can happen in both congenital and acquired ptosis.

Can ptosis go away on its own?

Ptosis from swelling or some nerve and muscle conditions can improve. Congenital and age-related ptosis usually do not, and need treatment if they affect vision.

Book a consultation with Assoc. Prof. Dr. Preamjit Saonanon in Thong Lo, Bangkok

• Book online: en.saonanonclinic.com/book-online

• LINE: @saonanon

• Phone: +66 90 946 3090

• Hours: Thursday 16:00–20:00 and Saturday 09:00–20:00 (Soi Thong Lo, Bangkok)

This article is general information and does not replace a medical examination. Results vary from person to person.