If you notice that both of your upper eyelids have become progressively droopy with age, then you probably have simple age-related ptosis. Some old photographs usually can confirm the diagnosis because they prove that your drooping eyelids have worsened gradually over the years.
In other cases of ptosis, a doctor must diagnose the problem. The doctor will begin by reviewing all of your symptoms, not just your eyelid complaints. This review includes any symptoms of double vision, muscle fatigue or weakness, difficulty speaking or swallowing, headache, or tingling or numbness anywhere in your body. Your doctor also will review your past medical history and ask about any family history of ptosis or inherited muscle diseases.
Then, your doctor will do a physical examination, a neurological examination, and a thorough examination of your eye. If your doctor finds anything abnormal, special diagnostic tests are necessary. For example, you may need a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan if you have signs of a neurological problem or if your eye examination reveals evidence of a mass or swelling inside your eye socket.
If you have muscle weakness or other symptoms of a muscle disease, your doctor may order a blood test for myasthenia gravis. Also your doctor may do a Tensilon test. Tensilon is the brand name for a medication called edrophonium chloride, which will be injected into a vein. If you have myasthenia gravis, the drug will reverse muscle weakness for a few minutes. A muscle biopsy also may be done to diagnose less common muscle problems. In a biopsy, a very small piece of muscle is removed so it can be examined under a microscope.