Underlying medical conditions
Certain underlying medical conditions can result in a drooping eyelid.
- Diabetes: As diabetes progresses, small blood vessels can be damaged, including ones that supply the oculomotor nerve. Disruption of the blood supply can cause a drooping eyelid along with decreased ability to move the eye.
- Headache syndromes: Some headache syndromes can present with eyelid drooping as an additional symptom.
- Thyroid disease: Abnormally high levels of thyroid hormone (hyperthyroidism or Grave's Disease) are more likely to cause pulled back eyelids than droopiness. However, in some cases, high thyroid hormone can cause the same neuromuscular disorder mentioned above, causing droopy eyelids.
This list does not constitute medical advice and may not accurately represent what you have.
Myasthenia gravis (over 50)
Myasthenia Gravis is an autoimmune disease, where the immune system attacks the connection between nerves and muscles.
Rarity: Rare
Top Symptoms: weakness, general weakness, trouble swallowing, voice change, double vision
Urgency: In-person visit
Stye or chalazion
A stye (or hordeolum) is an infection in the upper or lower eyelid. There are three glands around the eye and one of them is infected.
You can treat this on your own with a topical antibiotic and warm compresses to help drain the infected area.
Stroke or tia (transient ischemic attack)
Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.
Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.
Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.
A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.
Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.
Rarity: Common
Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck
Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness
Urgency: Emergency medical service
Mitochondrial myopathy
Mitochondrial myopathy includes a group of inherited genetic disorders that affect the muscles of the body.
Make an appointment with a physician to further analyze what genetic defects may be present, and begin prescription treatment.
Irritated eye causing swelling
Chemosis is a sign of eye irritation. The outer surface of the eye can look like a blister, filled with water or fluid. It can occur from infection or allergies, or as in this case, from rubbing the eye.
You can treat this on your own with eye drops from the pharmacy. "Antihistamine" drops like Zaditor (ketotifen fumarate) or Optivar (azelastine hydrochloride) will sooth and reduce swelling.
Inflamed eyelid (blepharitis)
Inflamed eyelid, or blepharitis, is a bacterial infection of the skin at the base of the eyelashes.
If the oil glands around the eyelashes become clogged, normal skin bacteria will multiply in the oil and cause infection. The glands can become blocked due to dandruff of the scalp and eyebrows; allergies to eye makeup or contact lens solution; or eyelash mites or lice.
Symptoms include red, swollen, painful eyelids; oily, dandruff-like flakes of skin at the base of the eyelashes; and eyelashes that grow abnormally or fall out.
If the symptoms do not clear with hygiene, see a medical provider. Blepharitis can become chronic and lead to infections of the eyelids and cornea; dry eyes which cannot take contact lenses; and scarring and deformity of the eyelids.
Diagnosis is made through physical examination of the eyelids, under magnification and through skin swab of the eyelashes.
Treatment includes warm compresses and careful washing of the eyelids; antibiotics in pill or cream form; steroid eyedrops; and treatment for any underlying condition such as dandruff or rosacea.
Hypothyroidism
Hypothyroidism, or "underactive thyroid," means that the thyroid gland in the neck does not produce enough of its hormones. This causes a slowing of the body's metabolism.
The condition can occur due to autoimmune disease; any surgery or radiation treatment to the thyroid gland; some medications; pregnancy; or consuming too much or too little iodine. It is often found among older women with a family history of the disease.
Common symptoms include fatigue, constantly feeling cold, weight gain, slow heart rate, and depression. If left untreated, these and other symptoms can worsen until they lead to very low blood pressure and body temperature, and even coma.
Diagnosis is made through a simple blood test.
Hypothyroidism is easily managed with daily oral medication. The patient usually starts feeling better after a couple of weeks and may even lose some extra weight. It's important for the patient to be monitored by a doctor and have routine blood testing so that the medication can be kept at the correct levels.
Cluster headache
A "new onset" cluster headache means that the person has never experienced a before. These headaches most commonly start after age 20.
A cluster headache is characterized by intense pain on one side of the forehead, especially over one eye. It often strikes in "clusters," meaning the headache comes and goes frequently. It may occur at about the same time of day for several days or weeks in a row.
The specific cause for cluster headache is not known. Drinking alcohol, breathing strong fumes, exercising to the point of becoming overheated, and heavy smoking are all possible triggers.
Diagnosis is made through patient history, since there is no specific test for cluster headache. Blood tests, neurologic tests, and imaging such as a CT scan or MRI may be done to rule out any other cause for the new onset of head pain.
Referral will be made to a headache specialist, who can offer new treatments to help the patient manage the symptoms and improve quality of life.
Rarity: Uncommon
Top Symptoms: severe headache, nausea, throbbing headache, history of headaches, sensitivity to light
Symptoms that always occur with cluster headache: severe headache
Urgency: Hospital emergency room
Carotid artery dissection
A carotid artery dissection is the tearing of the walls of the carotid arteries, which deliver blood to the brain from the aorta. This is a medical emergency.
Call 911 immediately. Diagnosis is done by CT or MRI, and treatment involves anti-clotting medication for at least 3-6 months. Surgery may be necessary for those who can't get this medication.
When to see a doctor for a drooping eyelid
In some cases, even though emergency treatment isn't necessary, you may need laboratory testing or radiology testing/imaging in order to make a diagnosis and select the best drooping eyelid treatment. Make an appointment with your medical provider if:
- Your eyelid drooping has worsened over time: Or is affecting your ability to see
- You have noticed muscle weakness in other parts of the body
- You have symptoms of high thyroid hormone: Such as weight loss or changes in your menstrual cycle
- You have noticed decreased peripheral vision
- You have previously been diagnosed with diabetes or a thyroid condition
Medical treatments
Your medical provider may prescribe one or more of the following treatments, depending on the cause of your drooping eyelid symptoms:
- Medication: This may be needed to suppress abnormal immune system activation or improve communication at the neuromuscular junction.
- Treatment for an underlying medical condition: Such as diabetes or increased thyroid hormone
- Referral to a surgeon
Treatment to address the drooping eyelid directly
Unfortunately, most causes of a drooping eyelid will not resolve without medical or surgical treatment.
- For allergies: If you have been diagnosed with an allergic disorder of the eyelid, avoiding allergens can help with drooping and discomfort.
- For neuromuscular conditions: Placing an icepack on the eye for a couple minutes can help improve eyelid drooping if a neuromuscular condition is the cause.