What is Ptosis? | Others' Experiences | Causes | Management | Support

People diagnosed with multiple sclerosis (MS) can experience many different vision problems. One such eye problem associated with MS is a droopy eyelid, or ptosis. Ptosis, however, appears less commonly than other eye issues (like optic neuritis). And it’s even more rare for ptosis to be your first symptom of MS.

Still, noticing a droop in one or both of your eyelids sets off alarms. Read on to learn more about the symptoms, causes, and management of ptosis — and when it’s time to talk to your doctor about treatment for droopy eyelids.

What Is Ptosis?

Doctors consider an eyelid “droopy” when it sags below its normal level. The causes behind a drooping eyelid include a number of factors, like muscle weakness and nerve damage.

Typically, a person with ptosis cannot open their eyelid past a certain point. Ptosis generally affects the upper eyelids but it might also involve the lower eyelids. Sometimes, droopy eyelids partially or fully block your vision or cause double vision (called diplopia).

MyMSTeam Members Chime in About Droopy Eyelids

A number of MyMSTeam members post about their droopy eyelids. “Droopy eyelid?” wrote one member, looking for others with the symptom. “Mine has started the past couple of weeks on the left eye.” Another member asked, “Does anybody else have issues with one droopy eye?” A third member answered in the affirmative, and said, “My left eyelid is droopy and my vision is blurry.”

Other members report that both of their eyelids droop. “Does anyone else experience droopy eyelids?” asked one MyMSTeam member. “My doc says my eyelid muscles have been affected. I look like I am half asleep.”

Sometimes, droopy eyelids develop along with other symptoms, like seeing double. “For the last couple of weeks, I have noticed my vision changing,” wrote one MyMSTeam member. “I went to the eye doc and got a prescription for some glasses. A couple days later, I noticed my vision was doubled and my left eyelid was drooping.”

On the other hand, some MyMSTeam members don’t even notice their ptosis. “Well, I have a droopy eyelid and did not know it,” one member explained. “My neuro-ophthalmologist said I have it in my left eye.”

What Causes Droopy Eyelids in Someone With MS?

Demyelination happens when the myelin sheath protecting the nerves gets damaged. Demyelination that appears in the central nervous system (CNS) serves as a hallmark of MS. And it is responsible for ptosis in MS. How? It disrupts the nerve signals from the brain to the muscles that control the eyelids, causing them to droop.

What Else Causes Droopy Eyelids?

The known causes of ptosis relate to the nerves or muscles (or both) that control your eyelids. And ptosis can come from conditions besides MS, too. Since people diagnosed with MS can also experience other conditions, let your health care team examine any newly drooping eyelids or those that worsen. Getting a definitive diagnosis for your change in symptoms could mean a visit to a neurologist or a specialist ophthalmologist.

Other conditions that can cause ptosis include:

• Bell’s palsy
• Myasthenia gravis
• Diabetes
• Tumors
• Horner’s syndrome
• A stye or other swelling in the eyelid

A droopy eyelid may also be associated with a stroke. Get immediate medical attention if your droopy eyelid happens alongside these symptoms:

• Sudden cognitive changes — Difficulty speaking, problems understanding others, or general confusion
• Sudden weakness or numbness — Occurring on one side of the body, and on the face, leg, or arm
• Problems with coordination — Dizziness, loss of balance, difficulty walking, etc.
• Vision problems — Changes in sight in one or both eyes
• Sudden, severe headache — Specifically those without an apparent cause

Managing Droopy Eyelids With MS

These days, a number of treatment options for ptosis exist. So if ptosis affects your vision, or the resulting change in your appearance bothers you, talk to your doctor. Your treatment will depend on the severity and cause of your ptosis — whether it’s related to problems with nerves or muscles.

Muscle Stimulation

In some cases, stimulating your levator muscle (the muscle that raises the eyelid) can help “jump-start” it and limit how long your ptosis lasts. Since this approach doesn’t solve nerve problems, it may be less likely to help someone with MS. But it can be a solid option when your doctor believes your eye muscle strength (or activity) is what caused your drooping eyelids.

Eyedrops

Some prescription eye drops cause muscle contractions that might open your droopy eyelids temporarily. But eye drops don’t solve any drooping problem permanently. And, since they also raise some people’s risk for developing glaucoma, they don’t rate as the right treatment for everyone.

Eyelid Props

Tape an eyelid open? Trick out glasses with special props to open them? Yes, such options exist. And they can both help your vision and change how your ptosis looks. But, remove the tape or glasses, and your eyelids droop again. Why? Neither makes for a permanent solution as neither addresses the problem that caused your drooping.

Botulinum Toxin (Botox)

Some people with drooping eyelids benefit from getting botulinum toxin (Botox) injections. Usually Botox helps people with eyebrow drooping the most. But for some people, the injections can also help cut down on drooping. That said, the shots may not be a long-term solution.

One MyMSTeam member talked about getting Botox shots to treat their ptosis. “I just got back from the plastic surgeon who used to give me Botox,” they wrote. “However, there is no room for Botox now. The muscles in my forehead are weakened, so he told me to go to a neuro-ophthalmologist.”

Surgery

Surgery proves to be the best option to treat ptosis in some cases. If your ophthalmologic surgeon recommends surgery, they will determine the best type for you. To settle on that, they look at the cause of your ptosis and its severity.

After their surgery, one member posted, “I had ptosis (droopy eyelid) surgery last Friday, and my eyelids still hurt! I’ve gone from dark purple to dark blue, green, rainbow, and now yellowish green. My vision is still blurry, and my eyes are swollen. My nose, under eyes, and cheeks are swollen as well. I had this done because my eye doctor said it was medically needed — I was seriously losing my peripheral vision.”

If surgery rates as the best option for treating your ptosis, find a surgeon you trust. Also consider getting a second opinion before undergoing the procedure.

Find Your Team

If you or a loved one is living with MS, consider joining MyMSTeam. Here, more than 184,000 members gather to discuss every topic related to multiple sclerosis. You can ask questions and get support from others who know what it’s like living with MS.

Are you experiencing droopy eyelids or other vision symptoms of MS? Share your story in the comments below or by posting on MyMSTeam.