patient education > droopy eyelids

Droopy Eyelids

Patients may complain of having droopy eyelids. Droopy eyelids can be caused by excess skin and fat (dermatochalasis), drooping eyelid (ptosis), eyebrow droop (brow ptosis) or a combination of these problems. No matter the specific cause, he symptoms, however, are often the same.

Symptoms:
Patients may notice difficulty reading or seeing while watching TV, or difficulty seeing to the side while driving; forcing the eyelids open seems to help. Patients with a droopy eyelid may complain of a headache or brow ache at the end of the day due to forcing the eyelids open to see better. Patients may also note their face may appear more tired or angry than in the past.

Excess skin or dermatochalasis overhanging the eyelid edge before surgery

6 weeks after surgery where excess skin was removed during blepharoplasty

Dermatochalasis:
Patients have excess skin and fat in their upper lids. This skin can overhang the eyelid edge obscuring the visual axis. Furthermore, this excess skin and fat can weigh the eyelid down causing it to droop. Finally the excess skin can cause eye irritation and can make blepharitis worse. Dermatochalasis is caused by aging, and excessive sun exposure.. It can also be worsened by recurrent eye infections, allergies, or eyebrow droop. It also runs in families.

Surgery for dermatochalasis is called blepharoplasty, often nicknamed an eyelid tuck. The surgery involves excision of excess skin and fat and closure of the wound with sutures.

Ptosis:

A droopy eyelid without significant dermatochalasis or excess skin is often caused by a weakened or stretched muscle of the eyelid. This causes the eyelid to rest lower in the visual axis. Ptosis is caused by aging an can be worsened with contact lens use or eye surgery. In some instances it is related to a neuromuscular condition like a stroke. Finally there is a familial component in which droopy eyelids run in families.

Ptosis of both upper eyelids before surgery

6 weeks after surgery to correct ptosis of both upper eyelids

A special case of ptosis occurs in childhood. Congenital ptosis or drooping of an eyelid since birth is due to an abnormally formed eyelid muscle. If not addressed early in life, the normal development of the eye can be irreversibly affected.

Surgery to fix ptosis involves tightening one of the two eyelid muscles which raise the eyelid. In most cases this is performed through an incision in the eyelid crease; therefore scarring after surgery is minimized. In younger patients it is sometimes possible to do the surgery from under the eyelid. In these cases there are no external scars at all.

Brow ptosis:
A droopy eyebrow can also make an eyelid look droopy causing difficulty reading or driving. It is also caused by aging changes or can be the result of a stroke or facial palsy (Bell's Palsy). Surgery to fix brow ptosis is focused at resuspending the eyebrow to underlying soft tissue through an eyelid crease incision, forehead incision, or scalp incision.

Surgery:
There are no good medical options to improve a droopy eyelid. Surgery for these problems is usually on an out patient basis under local anesthesia with intravenous sedation. Surgery typically takes 30 minutes per eyelid and if a patient has the problem on both sides, surgery on both sides can be performed at the same setting. Patients are seen one week after surgery at which time sutures are removed. Post-operative care involves applying an antibiotic ointment to the surgical incision and placing cold compresses or ice to the eyelids to reduce swelling. Although eyelid position is improved at one-week after surgery, final results are usually obtained at three to six months after surgery.

Reconstructive versus Cosmetic Surgery
You may find the eyelid drooping aesthetically objectionable. It may make you appear tired or lacking energy; people may comment you look more angry or stern than usual. However, if your drooping eyelid also effects your visual function, surgery to fix it may be covered by insurance. Surgery covered by insurance is considered reconstructive surgery.

Through a thorough examination performed by Dr. Bernardino, a determination will be made whether this is affecting your visual function. External photography and visual field testing may be required to establish that your eyelid droop is causing visual compromise.
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