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Do people often say you look tired because of your eyes? Droopy eyelids, known as ptosis, are a common symptom of myasthenia gravis (MG). In fact, about half of all people with MG experience an eye problem as a first sign of their condition.
Fifteen percent of people with diagnosed MG will only ever have eye symptoms such as ptosis. This is called ocular myasthenia gravis. Ocular MG exclusively weakens the muscles that control movement of the eyeballs and upper eyelids.
Here’s what you need to know about what causes ptosis and how to treat it. You’ll also see some pictures of drooping eyelids and pictures of ocular myasthenia gravis.
If you have ptosis, your eyelids fall, making it look like your eyes aren’t fully open. Ptosis can affect one or both eyes. (Adobe Stock)
In myasthenia gravis, eye muscles get tired easily because immune system antibodies damage the connection between nerves and muscles, causing droopy eyelids. (CC-BY-2.0/M. Kurukumbi, et al.)
The diagnostic process usually begins with a thorough history and exam, where a healthcare provider looks for signs like tiredness, double vision, and weakness in facial muscles.
They may also include tests for acetylcholine receptor (AChR) and antimuscle-specific tyrosine kinase (MuSK) antibodies and perform bedside fatigue assessments, ice pack tests, and electrodiagnostic studies if necessary.
If you’re experiencing eyelid drooping caused by MG, take heart: It can be treated with the same medications used for MG-related muscle weakness in other parts of your body, or sometimes with surgery.
Medication options for droopy eyelid treatment include options that help the muscles and nerves communicate better and ones that affect how the immune system works.
Cholinesterase inhibitors like pyridostigmine (Mestinon) help make sure there’s enough acetylcholine to help muscles contract.
Pyridostigmine can slow the body’s breakdown of acetylcholine, an important chemical that helps nerves communicate with muscle cells.
Corticosteroids (steroids) like prednisone can reduce the harmful effects of the immune system in MG. Corticosteroids work by blocking the immune system from producing damaging antibodies — immune proteins that identify infected cells and tag them for destruction.
Because corticosteroids reduce the amount of antibodies in general, they lead to a higher risk of infections as well as other side effects such as bone thinning, weight gain, and diabetes.
Medicines such as azathioprine and mycophenolate mofetil can also improve MG symptoms by changing aspects of the immune system. Immunosuppressants may be prescribed with corticosteroids.
If other medications don’t work well for your myasthenia gravis, your healthcare provider may recommend trying a newer drug. Medications approved in the past few years by the U.S. Food and Drug Administration (FDA) to treat generalized MG include:
In addition, use of efgartigimod (Vyvgart/Vyvgart Hytrulo) was expanded in 2026. People living with MG can now use efgartigimod regardless of their antibody status.
Surgery could be an option if a tumor called a thymoma is present on your thymus gland. It may also be an option if you’re living with generalized MG and your blood tests are positive for AChR antibodies, which may lead to MG.
The surgical removal of the thymus is known as a thymectomy. It can offer several benefits, such as improving muscle weakness and reducing the need for medication. However, a thymectomy isn’t a standard treatment if MG only affects your eyes.
If your ptosis doesn’t go away with medication, your ophthalmologist (eye disease specialist) might also recommend eye surgery such as eyelid elevation or lifting.
“Pyridostigmine didn’t work for me,” said one MGteam member. “I had to have the ptosis surgery to keep the eyelid up.”
Because MG varies from person to person, it’s important to discuss your treatment options, including risks and benefits, with your doctor. Make sure your doctor understands your goals and preferences so you can work together to find a treatment plan that suits you.
It may take time for you and your healthcare provider to find the combination of medications that works best for your drooping eyelids. Here are a few steps you can take at home to manage ptosis.
Ice packs and cold compresses can provide temporary relief for your drooping eyelids. Cooling the area around your eyelid for no more than 20 minutes can help your nerves and muscles communicate better for a short time, though it doesn’t treat MG directly.
An MGteam member shared, “When my eyes fatigue, I put cold compresses on them for about 15 minutes, and this seems to help me.”
Some people with one drooping eyelid might have double vision. A member of MGteam shared their experience: “It was one of the first symptoms I had along with drooping eyelids. It’s gone for the most part, but I still get it sometimes.”
Another member said, “I occasionally have double vision, especially when I’m fatigued.”
You can buy an eye patch to block one image if you’re seeing double, though it won’t help a droopy eyelid. If you wear glasses, you may also cover one lens of the eyeglasses to manage your double vision.
Another home remedy to help with ptosis doesn’t require spending any money. Finding ways to make the most of your energy may help. As one MGteam member mentioned, “Rest is the one prescription I forgot to take.”
Plan demanding activities for when you have the most energy. It’s also important to let yourself rest to lessen stress on your body.
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I ask ChatGPT for some exercise for droopy eye lids. Gave me about 4 exercises I could try, but was not to encouraging.
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