Drooping of upper eyelid (blepharoptosis) refers to the sagging of the eyelid, making it difficult to lift, which affects vision. In mild cases, it partially covers the pupil, while in severe cases, it completely obscures the black of the eye, making it hard to open.

This condition, Zhubing Yuanhou Lun refers to as "drooping of upper eyelid (blepharoptosis)," also known as "invasion of wind"; Puji Fang calls it "eyelid sagging"; Mujing Dacheng refers to it as "drooping of upper eyelid (blepharoptosis)." Additionally, it is also known as "tired eyelid" and "sagging eyelid." It is now uniformly called "drooping of upper eyelid (blepharoptosis)."

Drooping of upper eyelid (blepharoptosis) is generally divided into congenital and acquired types. Congenital drooping of upper eyelid (blepharoptosis) often affects both eyes and is caused by heredity or congenital developmental defects; acquired drooping of upper eyelid (blepharoptosis) usually affects one eye and results from post-illness, trauma, or other causes. If drooping of upper eyelid (blepharoptosis) is caused by intracranial or orbital tumors, it requires specialized treatment and is not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Sinking of Spleen Qi︰The clinical manifestations include a gradual onset with slow drooping of the upper eyelid, progressively worsening. In mild cases, it partially covers the pupil, while in severe cases, it completely obscures the black of the eye, making it difficult to open. Patients often tilt their heads and raise their eyebrows to see, and over time, deep wrinkles form on the forehead. In extreme cases, they may need to lift the eyelid manually to see. Systemic symptoms include general weakness, lack of strength, cold intolerance, shortness of breath, and flaccid limbs. The tongue appears pale and tender, and the pulse is weak, deep, and faint. Some may experience prolapse of rectum, and women may exhibit prolapse of uterus. Sinking of middle qi leading to drooping of the upper eyelid (blepharoptosis) is often caused by irregular diet or excessive worry damaging the spleen, compounded by preexisting spleen-stomach weakness, resulting in sinking of middle qi and the development of this syndrome. The middle energizer receives qi and transforms fluids into blood, while the liver governs all tendons, which rely on blood for nourishment. Spleen-stomach weakness and sinking of middle qi lead to weakened eyelid lifting. Insufficient blood fails to nourish the tendons, causing laxity and loss of restraint, hence drooping of the upper eyelid (blepharoptosis). Spleen-stomach qi deficiency develops gradually, so the drooping of the upper eyelid also worsens slowly. Therefore, the key diagnostic features of this syndrome are its slow onset, progressive worsening, and accompanying systemic symptoms of sinking of middle qi. Treatment should focus on tonifying the middle and replenishing qi, with the prescription selection being Middle-Tonifying Qi-Replenishing Decoction.
2. Wind Attacking the Channels and Collaterals︰The onset is relatively acute, with sudden drooping of the upper eyelid (blepharoptosis). It is also accompanied by itching as if insects are crawling, headache, eye distension, a red tongue, and a floating, rapid pulse. The drooping of the upper eyelid (blepharoptosis) is caused by external contraction of wind pathogens, which invade the interior and lead to apoplexy involving the collaterals, damaging the tendons and vessels. Wind is characterized by swift movement and rapid changes, hence the sudden onset. Clinically, it often manifests as abrupt drooping of the upper eyelid (blepharoptosis). When wind is excessive, it causes itching and surges upward to the head and eyes, resulting in headache and eye distension. The treatment should focus on nourishing blood and dispelling wind, and the recommended formula is Wind-Eliminating Impairment-Repairing Decoction.
3. Qi Stagnation and Blood Stasis︰There is a clear history of trauma to the eye or forehead area, and the drooping of the upper eyelid (blepharoptosis) is caused by trauma. It is mainly due to trauma to the eye or forehead, where static blood obstructs the meridians, causing the eyelid to sag and fail to retract, or where the tendons are severed, leading to qi stagnation and blood stasis, resulting in the eyelid's inability to lift. Treatment should focus on regulating qi and resolving stasis, with the recommended formula being the Stasis-Resolving Four Ingredients Decoction.

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1. Zhubing Yuanhou Lun．Eye Disease Syndromes: "The syndrome of drooping of upper eyelid (blepharoptosis). The eyes are the essence of the blood and qi of the zang-fu organs, and the external manifestation of the liver. However, the blood and qi of the five zang and six fu-organs all ascend to nourish the eyes. If there is a deficiency of blood qi, then the skin and pores open and are invaded by wind. When wind lodges between the skin of the eyelids, the skin becomes slack and droops over the eyes, making it unable to open. This is commonly called drooping of upper eyelid (blepharoptosis), also known as wind invasion."