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Noticing a droopy eyelid, whether it has happened seemingly overnight or you have simply spotted it for the first time in a photo, is unsettling. The good news is that in the large majority of cases, this is simply ptosis (a droopy eyelid): common, and very treatable.
We asked Miss Jane Olver, Consultant Ophthalmic Surgeon and Medical Director at Clinica London, to explain what usually causes a sudden droopy eyelid, when it is worth being seen promptly, and what treatment involves.
Most people with a droopy eyelid (ptosis) who come to see me should not have any serious medical cause to worry about, but we always make sure everything is alright. I am always happy to see a patient promptly and calmly when they are worried by a droopy eyelid or even two droopy eyelids. There is no need to wait, it is always best to get it checked out. Just occasionally there is a neurologic or neuro-muscular cause which needs to be detected and treated.
— Miss Jane Olver, oculoplastic surgeonNot every droopy eyelid that feels sudden has appeared overnight. At Clinica London, we tend to see three different patterns, and which one applies changes what is likely going on.
By far the most common reason for a droopy eyelid in adults is involutional ptosis: a gradual stretching or weakening, with age, of the muscle that lifts the eyelid (the levator muscle). This is exactly the kind of ptosis that is often "suddenly noticed" rather than suddenly appearing, spotted in a photo, or pointed out by someone who has not seen you in a while. It is more common in long-term contact lens wearers, and it can run in families, so if an older relative has had ptosis, you may be more likely to develop it too.
Involutional ptosis is straightforward to assess and, if you would like it corrected, straightforward to treat surgically.
Assessing eyelid position at Clinica London.
A droopy eyelid that has genuinely and rapidly appeared, particularly if it is continuing to get worse, is more likely to have a neurological cause, meaning it originates from the nerves controlling the eyelid and eye rather than simple muscle stretching. Sudden onset ptosis, in this true sense, is neurological in origin. This is much less common than involutional ptosis, but it is why we would always recommend being seen rather than waiting.
Four of the main neurological causes are: Horner's syndrome, where a disrupted nerve pathway causes a mild droop alongside a smaller pupil on the same side; third Cranial Nerve palsy, which can cause a more pronounced droop along with double vision or a dilated pupil, and occasionally needs urgent imaging to rule out an intracranial aneurysm; myasthenia gravis, where the ptosis is variable and worse when tired; and ocular myopathy, where as well as the ptosis, the eye movements are restricted. All four are uncommon, but warrant a prompt assessment to identify or rule out.
⚠ Double vision, a severe sudden headache, or an unequal pupil, alongside a droopy eyelid, is a true emergency.
Seek same-day medical attention rather than waiting for a routine appointment. If you also notice slurred speech or weakness down one side of the body or face, call 999: this combination can be a sign of stroke.
⚠ Variability of the droopy eyelid during the day, or limited/restricted eye movements, needs urgent oculoplastic assessment.
This is not a reason to worry unnecessarily. Most people who come to see us do not have anything serious going on. It is simply a reason to be seen calmly and promptly rather than waiting, exclude the above, including if you are away on holiday. Do not wait until you are back home to get it checked; an ophthalmic oculoplastic opinion is a phone call away.
Concerned right now? Book an urgent eye assessment →Ophthalmologists who are specifically trained in assessing eyelids and ptosis, and in carrying out the surgical treatment, are known as oculoplastic surgeons. At Clinica London, eyelid assessment and ptosis surgery are carried out regularly by our team of three oculoplastic surgeons, and if surgery is required, this is carried out in our dedicated ophthalmic operating theatre.
An oculoplastic ptosis consultation involves examining the eyelid position, checking pupil responses, checking the eye movements, making the diagnosis and talking through when the change was first noticed and whether anything else has changed. If needed, we refer on to a neurologist, as we would for any patient where neuro-imaging is required, to exclude a neurological cause, or to arrange special tests for Horner's syndrome or myasthenia.
For the correction of the ptosis itself, eyelid surgery is usually carried out under local anaesthetic, and lends itself particularly well to this approach. The scar is hidden within the natural eyelid crease, becoming invisible once healed.
✅ Day case surgery, performed on-site at Clinica London under local anaesthetic. A combination of sutures and glue is used, with suture removal a week after surgery.
Ptosis assessment at Clinica London, 140 Harley Street.
An oculoplastic consultant-led assessment at Clinica London, 140 Harley Street, to confirm what is causing your droopy eyelid and whether treatment is appropriate.
Book a consultation nowIt is worth considering an assessment if:
You do not need a GP referral to be seen at Clinica London; we welcome self-referrals. Call us directly on 020 7935 7990 or book online. Please note that if you are covered by health insurance, your insurer may require a referral letter from your GP before they agree to cover the cost.
No. Most droopy eyelids, even ones that seem to have appeared suddenly, are simply involutional ptosis and not a sign of anything serious. Arrange to be seen within two to three days if it has genuinely appeared rapidly, and seek same-day attention if it comes with double vision or an unusually dilated pupil, since that combination is a true emergency.
A genuinely sudden appearance, especially if it is still getting worse, is more likely to have a neurological cause and is worth being seen promptly. Far more often, what feels sudden is simply a gradual, longstanding droop that has only just been noticed, in a photo, for example, or by someone who has not seen you in a while. This is usually simple involutional ptosis.
Fatigue can make an existing mild ptosis more noticeable, but tiredness alone does not usually cause a genuinely new droopy eyelid. Often there is a compensatory eyebrow lift on the droopy eyelid side, and when tired, the eyebrow relaxes and the lid looks more droopy.
Once assessed, most patients are offered ptosis surgery, carried out under local anaesthetic as a day case by one of our oculoplastic surgeons in our dedicated ophthalmic operating theatre.
No. Surgery is carried out through the natural eyelid crease, so the scar is invisible once healed.
Recovery is rapid, taking 5 to 10 days for bruising to settle. Stitches come out at one week. By three weeks after surgery the eyelid looks almost normal, in its new position.
No, we welcome self-referrals. You can call us directly on 020 7935 7990 or complete our online enquiry form. If you are covered by health insurance, your insurer may require a referral letter from your GP before agreeing to cover the cost, so it is worth checking your policy in advance.
A few other things can cause, or mimic, a droopy eyelid.
Call us on 020 7935 7990 or book online to speak with our ophthalmic and oculoplastic team.
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Miss Jane Olver, FRCS FRCOphth, is Consultant Ophthalmic Surgeon and Medical Director at Clinica London. She founded Clinica London in 2010 and has over 30 years' experience as an oculoplastic surgeon, specialising in blepharoplasty and ptosis surgery in both children and adults. She previously spent 20 years as a consultant oculoplastic surgeon at Imperial College NHS Trust, and is a co-founder of the British Oculoplastic Surgery Society and Immediate Past President of the International Society of Dacryology and Dry Eye.
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