The HEALTH | July-August. 2026

DROOPY EYELIDS: Ptosis occurs when the upper eyelid sits lower than it should due to a problem affecting the muscle or nerve responsible for lifting the eyelid

EYE CARE: Simple habits such as avoiding frequent eye rubbing, maintaining proper contact lens hygiene and managing dry eyes early can help protect overall eye and eyelid health

• Droopy eyelids are not always a cosmetic issue and may indicate an underlying medical condition requiring professional assessment.

• Understanding the difference between ptosis and naturally hooded eyelids is key to choosing the right treatment.

• Sudden-onset ptosis should never be ignored, as it may be an early warning sign of a serious neurological condition.

Unlike purely aesthetic concerns, ptosis occurs when the upper eyelid droops lower than normal, potentially obstructing vision and causing eye strain or discomfort. Findings from the National Eye Survey III indicate that about 13.5 per cent of adults, particularly those over 60, experience ptosis, underscoring the importance of timely assessment when symptoms interfere with daily life.

According to Sunway Medical Centre Velocity’ s( SMCV) Consultant Ophthalmologist and Oculoplastic Surgeon Dr Nazila Ahmad Azli, ptosis accounts for about 8 per cent to 12 per cent of her eyelid cases. While it may first appear cosmetic, proper assessment is essential because the condition may involve muscle weakness, nerve dysfunction or other underlying medical issues.

Dr Nazila Ahmad Azli

UNDERSTANDING PTOSIS

The upper eyelid relies on muscles and cranial nerves working together to open and close the eye. The levator palpebrae superioris lifts the eyelid, while the orbicularis oculi closes it.

“ In simple terms, ptosis means drooping of the upper eyelid. The upper eyelid works through muscles that control the opening and closing of the eyelid, and ptosis occurs when either the muscle or the nerve that innervates it malfunctions,” said Dr Nazila.

Ptosis may affect one or both eyelids and can be present at birth or develop later in life. Congenital cases usually result from incomplete development of the eyelid-lifting muscle, while acquired ptosis may be linked to ageing, injury, previous eye surgery, prolonged contact lens use, frequent eye rubbing or conditions affecting muscle or nerve function.

It is also commonly mistaken for hooded eyelids or excess eyelid skin. However, true ptosis involves a lowered eyelid margin, whereas dermatochalasia involves excess skin or fat while the eyelid remains in its normal position. This can create the appearance of a drooping eyelid margin even when the condition is not true ptosis, which is referred to as pseudoptosis.

MEDICAL COSMETIC DIFFERENCES

Because ptosis can resemble excess eyelid skin, it is often confused with cosmetic eyelid surgery. Blepharoplasty removes or repositions excess skin, fat or tissue to improve appearance, whereas ptosis correction restores the height and function of the upper eyelid by repairing the muscle or its supporting structures.

“ People may confuse ptosis surgery with cosmetic eyelid surgery because on the surface, both procedures improve the appearance of a person. However, both surgeries correct different structures of the eyelid. In some instances, these two surgeries may complement each other and may need to be done simultaneously to achieve an optimal outcome,” explained Dr Nazila.

She stressed that accurate diagnosis is essential before surgery, as treating ptosis without identifying its cause may result in recurrence or poor outcomes. More importantly, assessment helps rule out serious underlying conditions.

RECOGNISING WARNING SIGNS

Assessment includes a medical history, eyelid measurements, levator muscle testing, pupillary and eye movement examinations, and visual field analysis where necessary.

Although ptosis often develops gradually with age or after eye surgery, sudden-onset ptosis requires urgent medical attention. It may signal a brain aneurysm, stroke or carotid artery dissection.

Treatment depends on the cause and severity. Mild cases may be monitored, while more severe cases may require surgery to restore eyelid function, improve vision and enhance facial balance. Dr Nazila said treatment should always be individualised.

People can also support eye health by avoiding excessive eye rubbing, practising good contact lens hygiene, taking regular screen breaks, managing dry eyes early and using preservative-free eye drops where appropriate. While prolonged screen use and dry eyes do not directly cause ptosis, they may encourage frequent rubbing that places unnecessary strain on the eyelids.

Ultimately, droopy eyelids should not be dismissed as tiredness, ageing or a cosmetic concern, particularly when they affect comfort, vision or daily activities.

“ Do not take ptosis lightly because ignoring it can lead to vision impairment, chronic discomfort, and it can mask serious underlying medical conditions such as nerve damage, stroke, brain aneurysms or neuromuscular diseases. When in doubt, seek medical assistance from your nearest healthcare provider,” said Dr Nazila.- The HEALTH