Causes

When someone has acquired blepharoptosis—also known as droopy eyelid—it may impact how well the person can see, and how that person sees him or herself.1

Droopy eyelid may result from an underlying issue requiring additional medical attention such as neurologic conditions. It’s important to have it examined by an eye care provider to establish its cause and possible effects on your vision.2

No two cases are exactly alike. Each person’s case of droopy eyelid should be assessed and managed on an individual basis. Focused neurological examination should be conducted prior to treating droopy eyelid. In some cases, droopy eyelid can be a sign of more serious underlying neurological disease.2

Prevalence

In the United States alone, millions of American adults are estimated to have some degree of droopy eyelid.3,4*

Not an actual patient.

*Estimated U.S. population over 50 years of age with blepharoptosis calculated as estimated number of individuals aged 50 and older (U.S. 2020 Census) multiplied by 11.5% prevalence observed in study by Sridrahan et al.4

Can Affect One Eye or Both

Diagnosing droopy eyelid may seem obvious based on appearance, but there’s more to it than that. Patients with drooping upper eyelids should bring it up with an eye care provider for three main reasons:

1. To determine the cause

Although typically a result of age-related changes, droopy eyelid can also result from underlying medical conditions that may be serious. Examples include myasthenia gravis, stroke or brain tumor, nerve injury, and floppy eyelid syndrome (an inflammatory condition more serious than it sounds). Physical injury can also cause or worsen droopy eyelids.2

2. To uncover imposters

The eye care provider will want to rule out conditions that can mimic droopy eyelid, such as excess eyelid tissue (dermatochalasis), abnormal size or positioning of the eye, or a chronic facial twitch. Treatments may be available for some of these conditions.2

3. To gauge severity

Clinically, the severity of droopy eyelid is measured by how low the upper eyelid is drooping and how much it may be limiting one’s visual field—and, in turn—daily functioning. Two key clinical measurements to assess severity are:2

Marginal Reflex Distance 1

This measures the vertical distance from the center of the pupil to the edge of the upper eyelid. The shorter the distance, the more severe the drooping and, likely, the greater the impact on visual function.5

Visual field testing

Not an actual patient.

In this commonly used test, the patient looks straight ahead into a specialized device that flashes points of light around the center of his or her gaze. By pressing a button for each flash the patient sees, the field of vision can be plotted on a chart, along with a numeric score.6

Impact

When droopy eyelid affects vision, it can interfere with day-to-day functions, such as reading, driving, computer use, and looking up without the need to tilt one’s head back. Droopy eyelid can impact not only vision but appearance, which can be distressing for some, but not all, affected individuals.1

Treatment Options

In the past, the only available treatment for droopy eyelid was surgery, which is usually reserved for cases where the effects on vision severely limit daily functioning. In those cases, surgery can improve visual function.5 However, not everyone with severe droopy eyelid is a good candidate for surgery.2,5

A different kind of treatment has become available for patients with droopy eyelid. UPNEEQ is the first and only topical treatment option for adults with droopy eyelid.7

References:

  1. Richards, HS, Jenkinson E, Rumsey N, et al. The psychological well-being and appearance concerns of patients presenting with ptosis. Eye. 2014; 28(3):296-302.
  2. Finsterer J. Ptosis: causes, presentation, and management. Aesthetic Plast Surg. 2003;27(3):193-204.
  3. Sridharan GV, Tallis RC, Leatherbarrow B, Forman WM. A community survey of ptosis of the eyelid and pupil size of elderly people. Age Ageing. 1995;24:21-24.
  4. US Census Bureau, Population Division. Table 9: Projections by sex and age for the United States: 2015 to 2060. NP2014-T9. https://www2.census.gov/programs-surveys/popproj/tables/2014/2014-summary-tables/np2014-t9.xls. Accessed June 22, 2020.
  5. Cahill KV, Bradley EA, Meyer DR, et al. Functional indications for upper eyelid ptosis and blepharoplasty surgery: a report by the American Academy of Ophthalmology. Ophthalmol. 2011; 118(12):2510-2517.
  6. Ho SF, Morawski A, Sampath R, Burns J. Modified visual field test for ptosis surgery (Leicester Peripheral Field Test). Eye. 2011;25:365-369.
  7. UPNEEQ™ (oxymetazoline hydrochloride ophthalmic solution) 0.1%. [Prescribing Information]. RVL Pharmaceuticals, Inc. 2020.