Why Your Eyelids Get Droopy as You Age and What You Can Do About It

You may first notice droopy eyelids in a photo or while looking in the mirror: The upper lids sit lower than they used to, extra skin folds over the eyelid crease, or the eyes don’t look as open as they once did.

Some changes in the eyelids and brow are expected because of aging and gravity’s effect on our faces, and it’s mainly a cosmetic issue. But drooping eyelids can also affect how well you see if the lid or extra skin starts blocking your vision.

If you’re unhappy with the appearance of your drooping eyelids there are steps you can take to alter how you look. You may also want to talk to your doctor to distinguish between expected age-related changes to the eyelids and those that signify a medical problem that requires treatment.

Age-related droopy eyelids usually fall into two main categories — ptosis and dermatochalasis.

A third condition in which the eyebrows drop, called brow ptosis, can also make eyelids look droopy.

“Many people have a little bit of all three of these issues, especially the sagging eyebrow and extra skin,” says Julian Perry, MD, an oculoplastic surgeon at Cleveland Clinic Cole Eye Institute in Ohio.

Your Eyelid Muscle Gets Stretched, Weakened, or Separated

Ptosis, also called blepharoptosis, means the upper eyelid sits too low.

This can occur with aging because, over time, natural wear and tear from gravity, blinking, and years of eyelid movement can cause the levator tendon — part of the muscle system that lifts the upper lid — to stretch, weaken, or separate from the eyelid, says Andrea Tooley, MD, an ophthalmologist and oculoplastic and orbital surgeon at Innovative Ophthalmology in Kentucky and a clinical spokesperson for the American Academy of Ophthalmology.

“Ptosis can get worse near the end of the day, especially if a person has been compensating by lifting the brows or tilting the head back to see better,” says Dr. Tooley.

Your Eyelid Skin Gets Loose and Starts to Sag

Your Eyebrow Drops

Brow droop, or brow ptosis, happens when the eyebrow descends from its normal position.

The muscles and support structures around the eye and the outer portion or tail of the brow can sag with age, says Jason Aaron Liss, MD, an ophthalmologist, oculoplastic surgeon, and an assistant professor of ophthalmology at Duke University School of Medicine in Durham, North Carolina.

While eyelid drooping can be a natural part of aging, other factors may come into play.

Contributing Lifestyle Factors Smoking, sun exposure, and eye rubbing also stretch and damage the delicate skin around the eye, leading to more skin laxity and sagging, says Tooley.

Deciding whether droopy eyelids are a medical issue depends on how much they are affecting vision, comfort, and daily function, says Dooley. If one or both eyelids droop just a little and you mainly notice when you look at yourself in pictures, it’s likely mostly cosmetic, she adds.

Visual Impairment If the eyelid droops so much that it covers the eye or you need to hold up your lid to see better, your vision can be affected. “There are cases where the eyelid droops enough to cover the pupil and significantly disrupts the eye’s ability to see well,” says Dooley.

If droopiness around the eyes is affecting your vision or making it difficult to drive or read, you should see an eye-care specialist, says Tooley.

While aging is the most common cause of droopy eyelids, there are other causes as well.

“Sometimes ptosis happens as a side effect after eye surgery. Eye injuries, nerve damage, autoimmune conditions such as myasthenia gravis or sometimes even tumors can also affect the eyelid muscle, leading to ptosis,” says Dooley.

When to Seek Emergency Care

Dooley advises people to seek care right away if they experience any of the following symptoms, which could be the sign of a medical emergency like a stroke:

• Double vision
• Eye pain
• Sudden drooping or decreased vision
• One eyelid suddenly drooping or closing
• Difficulty opening your eyes

Treatment depends on what is causing the heaviness: the eyelid-lifting muscle, excess skin, the brow, or some combination.

Which issue is causing droopy eyelids can be tricky and requires a complete physical examination by an oculoplastic surgeon, says Dr. Perry.

Your doctor will also ask about your symptoms in order to “tease apart which of these factors is bothering you cosmetically as well as functionally in terms of vision,” he says.

Nonsurgical Options

Prescription eyelid-lifting drops may help some people with mild to moderate ptosis. The drops can provide about 1 to 2 millimeters (mm) of eyelid lift, with effects lasting about eight hours, says Dr. Liss. “The downsides are that the effect is temporary, the drops can be expensive, and some people may be sensitive to them,” he says.

Cosmetic injectables may help in select cases, but they do not fix true eyelid drooping or remove extra skin. “Botox or similar agents can create a mild brow lift for about three months, which may reduce some upper-lid overhang,” says Liss. Fillers are mainly used for hollowing or volume loss, though they may give the brow a slightly lifted appearance, he says.

Skin-tightening procedures such as radiofrequency, laser resurfacing, and similar treatments may soften fine wrinkles or slightly reduce excess skin, but “really do not play a role in treating droopy eyelids or excess upper eyelid skin,” says Liss

Surgical Options

A form of surgery called blepharoplasty can treat drooping eyelids when excess eyelid skin is the main problem. “We basically remove a strip of extra skin from the eyelid and sometimes manipulate or remove some of the fatty puffy tissues beneath the skin,” says Perry.

“Ptosis repair is a different surgery that aims to tighten, shorten, or reposition the muscle that raises the eyelid,” says Liss.

Deciding which surgery is best is sometimes a judgment call and requires a careful examination by the surgeon, says Liss. “If the dominant problem is the excess skin overhanging the eyelid margin or weighing down the eyelid, then a blepharoplasty will likely be the procedure chosen,” he says.

But if gently lifting the excess skin on examination reveals that the eyelid margin itself sits low across the pupil, it’s likely that a ptosis repair procedure is the best route, he says.

Insurance Coverage

Insurance coverage to rectify droopiness around the eye usually depends on whether there are any vision issues.

There are three basic criteria that insurance companies use: symptoms, photographs, and visual field tests, though how those elements are weighted can vary from company to company, says Perry.

To be eligible for coverage, the photos should demonstrate sufficient excess skin or droopiness and the visual field is to show that vision is limited by the drooping eyelid and improves with taping the eyelid higher. “If your surgeon works with insurance plans, their office will generally take the photos and administer the visual field test,” he says.

Age-related eyelid drooping is not always preventable, especially if you have a family history.

“It is difficult to avoid age-related eyelid droop, but taking care of your general health and keeping up with eye exams is a good way to minimize and treat eye conditions before they affect your daily life,” says Tooley.

Avoid smoking, wear sunscreen or sunglasses to protect the eyes, and avoid aggressive eye rubbing protect the delicate eyelid skin and tissues, says Tooley.