Ptosis is not a single condition — it has several distinct types, each with a different underlying cause. Understanding which type you or your family member may have helps in choosing the right approach to management.
Ophthalmologists classify ptosis according to its cause. The five recognised types are: congenital, aponeurotic (involutional), neurogenic, myogenic, and mechanical. Each type has a different origin, different typical presentation, and different management considerations.
This page provides a plain-language overview. For a diagnosis of your specific type, an ophthalmologist or oculoplastic surgeon should be consulted.
What it is: Ptosis that is present from birth. It occurs when the levator muscle — the muscle responsible for lifting the upper eyelid — fails to develop properly during foetal development.
Who it affects: Infants and children. It may be unilateral (one eye) or bilateral (both eyes). Congenital ptosis accounts for the majority of ptosis cases in children.
The upper eyelid appears noticeably lower than the other from infancy. The child may tilt their head back or raise their brow to see clearly.
In young children, significant ptosis covering the pupil can impair visual development and contribute to amblyopia (lazy eye). Early assessment by a paediatric ophthalmologist is important.
ARTView ptosis crutch glasses are used in some congenital ptosis cases to support the eyelid — particularly while surgical decisions are being made or in older children. See our kids range.
What it is: The most common type of ptosis in adults. It occurs when the levator aponeurosis — the tendon connecting the levator muscle to the eyelid — stretches, thins or partially detaches over time. This causes the eyelid to droop progressively.
Who it affects: Primarily middle-aged and older adults. It may also occur after eye surgery (particularly cataract surgery) or prolonged contact lens wear — both of which can stress the aponeurosis.
Gradual drooping of one or both upper eyelids, often worsening over months or years. The eyelid crease may appear higher than normal as the lid descends.
Natural ageing of the connective tissue, combined with years of daily eyelid movement, causes the aponeurosis to lose integrity. Post-surgical changes or contact lens wear can accelerate this process.
Aponeurotic ptosis responds well to ptosis crutch glasses in many cases, as the levator muscle itself often retains some function — the eyelid just needs mechanical assistance to reach the correct height. View ARTView glasses →
What it is: Ptosis caused by a problem with the nerve supply to the eyelid muscles. The two most common neurogenic causes are third cranial nerve palsy and Horner's syndrome.
Who it affects: Can affect people of any age. Neurogenic ptosis may appear suddenly and often warrants prompt medical investigation to identify the underlying cause.
The oculomotor nerve (cranial nerve III) controls the levator muscle. Damage — from stroke, aneurysm, trauma or diabetes — can cause significant drooping, often accompanied by eye movement problems.
Caused by interruption of the sympathetic nerve pathway. Produces a milder droop (2–3mm), along with a smaller pupil on the affected side. Causes include lung tumour, carotid artery dissection and other conditions.
Sudden onset ptosis — particularly with double vision, pupil changes or pain — requires urgent medical evaluation. Do not assume it is age-related if it appeared suddenly.
What it is: Ptosis resulting from a problem with the eyelid muscles themselves — either the levator muscle or the superior tarsal muscle (Müller's muscle). The nerves are functioning, but the muscles are weakened or diseased.
Who it affects: Associated with conditions including myasthenia gravis, chronic progressive external ophthalmoplegia (CPEO), and myotonic dystrophy.
An autoimmune condition that disrupts the signal between nerves and muscles. Ptosis in myasthenia is typically variable — it may fluctuate during the day, often worsening with fatigue.
A progressive condition affecting eye movement muscles. Ptosis is usually bilateral and symmetrical, developing slowly over years.
Ptosis crutch glasses are used in some myogenic cases — particularly in myasthenia gravis — to provide consistent eyelid support when muscle function is unreliable. Always in conjunction with medical management of the underlying condition.
What it is: Ptosis caused by a physical load or obstruction on the eyelid — the muscle is functioning but cannot overcome the weight or restriction pressing the lid down.
Who it affects: Anyone with a mass, lesion, or swelling on the upper eyelid — including chalazion (eyelid cyst), tumours, severe oedema or scarring from trauma or previous surgery.
Large chalazion, eyelid tumours (benign or malignant), amyloid deposits, extensive scarring, or severe allergic swelling pressing the lid downward.
Treatment of the underlying cause — removal of the mass or lesion — often resolves the ptosis. Ptosis crutch glasses may be used in the interim period while awaiting treatment.
Any new eyelid lump or swelling causing drooping should be assessed by an ophthalmologist to rule out serious underlying pathology.
Ptosis crutch glasses work by mechanically supporting the upper eyelid — they are not type-specific. However, they tend to be most effective in the following scenarios:
Aponeurotic (age-related) ptosis — the most common type. The levator muscle retains partial function; the glasses provide the additional lift needed. Results are generally very good.
Congenital ptosis (in children and adults), myogenic ptosis where the droop is manageable in degree, and post-surgical ptosis while recovery is ongoing.
Neurogenic and mechanical ptosis — glasses may provide daily comfort support while underlying medical management proceeds. Not a substitute for treatment of the underlying cause.