Ptosis · droopy eyelids
Droopy eyelids (ptosis): why a lid sits low — and what actually helps.
That heavy, tired-eyed look is usually acquired blepharoptosis: the lid’s lifting structures loosen with age, contact lens wear, or after eye surgery. It is common, measurable, and — for the right candidate — treatable without surgery. Here is the plain-English guide from our Los Angeles optometrists.
Medically reviewed by Dr. Bijan Cohenmehr, OD
What a low lid looks like.
Ptosis is more than a cosmetic quirk — these are the signs our optometrists in Los Angeles hear about most.
The permanent tired look
Friends ask if you slept, photos show one eye smaller, and makeup disappears under the fold. Often worse at night or after screen work.
Brow strain and headaches
You lift the lid with your forehead instead. By evening the brow aches, and many patients do not connect the two until the lid is treated.
A shrinking upper view
The lid crops the top of your visual field: overhead signs, cabinets, the serve in tennis. Chin-up head posture is the tell.
One side lower than the other
Asymmetry is typical. A droop that is new or rapidly changing needs same-day attention (an emergency room when we're closed); with double vision, eye pain, a severe headache or a pupil that looks different, call 911.
What causes it.
Aging (the usual culprit)
The levator aponeurosis (the sheet that lifts the lid) stretches and slips with time. The muscle works; its attachment has loosened.
Contact lens wear
Years of lid stretching during insertion and removal, particularly with rigid lenses, is a recognized cause of earlier-onset droop.
After eye surgery or injections
Cataract surgery, LASIK lid specula, and occasionally cosmetic botulinum toxin can each leave a temporary or lasting droop.
Nerve and muscle conditions
Third-nerve palsy, Horner syndrome, and myasthenia gravis all present with ptosis, which is why a real exam, not a checkout page, should precede treatment.
Treatment, honestly
Two real options — a daily drop, or surgery.
For mild-to-moderate acquired ptosis, Upneeq® lifts the lid within about 15 minutes, once a day, with no downtime. For severe droop, loose skin, or weak levator function, surgical repair is the right tool. Every Upneeq order here is reviewed by a doctor first, and if the drop is the wrong answer for your lids, we say so and refund you.
Frequently asked questions.
What is ptosis?
Ptosis (pronounced TOE-sis) is the medical name for an upper eyelid that sits lower than it should. Doctors call the adult-onset form acquired blepharoptosis. It can affect one eye or both, and it ranges from a subtly tired look to a lid that blocks part of your vision.
Why do eyelids start to droop with age?
The most common reason is stretching of the levator aponeurosis — the tendon-like sheet that lifts the lid. Decades of blinking, eye rubbing, and tissue aging gradually loosen it, so the lid rests lower even though the muscle itself still works.
Can contact lenses cause a droopy eyelid?
Yes. Long-term contact lens wear, especially with rigid lenses, is a well-documented contributor, likely from years of lid manipulation during insertion and removal. We see this regularly in lifelong lens wearers.
Is a droopy eyelid ever an emergency?
A droop that appears suddenly needs a same-day look: call us at 310-828-2010, or go to an emergency room when we're closed. If it comes with drooping on one side of the face, trouble swallowing or speaking, weakness, double vision, eye pain, a severe headache or a pupil that looks different, call 911: those can be signs of a stroke or another nerve emergency.
What is the difference between ptosis and extra eyelid skin?
Ptosis is the lid margin itself sitting low. Dermatochalasis is loose, redundant skin folding over the lid. They look similar and often coexist, but the treatments differ: skin excess needs surgery, while mild-to-moderate ptosis can respond to Upneeq. An exam tells them apart in minutes.
Can ptosis affect my vision?
Yes — a low lid narrows the upper field of vision. People compensate by raising their brows or tipping their chin up, which causes forehead fatigue and headaches by the end of the day.
Do children get ptosis?
Congenital ptosis exists and is managed differently — usually by a pediatric specialist, surgically when it threatens vision development. Upneeq is approved for adults.
How is ptosis diagnosed?
A standard part of a comprehensive eye exam: we measure the lid position (MRD-1), check the levator muscle function, rule out neurologic causes, and photograph the lids. No special preparation is needed.
Can Upneeq fix every droopy eyelid?
No — and we will tell you honestly. Upneeq works on mild-to-moderate acquired ptosis where Müller’s muscle can still lift the lid. Severe droops, skin excess, and congenital cases usually need surgery. That is exactly what the doctor review on every order screens for.
Does insurance cover ptosis treatment?
Surgical repair is sometimes covered when visual field testing proves functional loss. Upneeq is generally self-pay; most HSA and FSA cards work. A ptosis evaluation in our office is billable to most vision and medical plans.