Causes of "Droopy Lids"
Eyelid disorders are all too common especially in Southern California. These are due to many causes. Some of which are just merely aging of the musculature of the eyelids or from chronic exposure to sunlight, especially the ultraviolet light that is so prevalent here in California.
There are two major problems with the upper lid that can cause either cosmetic and/or medical problems. One is drooping of the eyelid muscle itself, better known as ptosis. The other is drooping of the eyelid skin, which is caused by a redundancy of the skin and can be associated with “bags.” Bags are fat pads that have prolapsed through their membranes, creating a bulging of the skin. The fat layer that supports the eye is held in place by a fibrous tissue called the septum. As one ages, the septum weakens and you will see the fat prolapsing, causing bags either on the upper eyelid or the lower eyelid. Usually these are cosmetic blemishes that one elects to either have removed for cosmetic reasons or learns to tolerate. Frequently, the drooping of the skin is so significant that it causes visual field defects and actually blocks the field of vision. This drooping of the skin can also cause asthenopia, which is fatigue due to the increased weight of the eyelids and the effort to keep the eyelids open. One uses the brow to elevate the eyelid, which will eventually cause fatigue, especially late in the evening.
It is important to be realistic about what blepharoplasty, or removal of this skin and/or fat, would obtain for you. It can result in actual medical improvement and significant enhancement of vision as well as cosmetic value. An easy way to determine what results can be achieved is to elevate your eyelids with your hand or with a piece of tape to the position they would be in following surgery. By looking in a mirror, you can then estimate what the post-surgery results would look like. This also gives you an opportunity to be able to ascertain if your vision would improve by the increased light that would enter the eye and by the decreased weight on your upper lid. By putting a piece of tape on the lid for an hour or two and then removing it, you would be aware of this change.
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Another problem associated with eyelids can be in the levator muscle. This can happen at birth or as one ages. The muscle in the eyelid weakens and sometimes causes a dehiscence, or holes, in the muscle. The lid begins to slowly droop down. You may notice a tendency to use your eyebrow more extensively to lift up the lid to get a better view. In extreme cases, you begin to tilt your chin upward so you have a better view through the droopy lid. Ptosis, or weakness, caused by the levator muscle (like any other muscle) is frequently found to be worse in the evenings. Frequently, you will find that as you continue to read, the eyelid will droop to the point of closure. Again, taping the lid will show what improvement can be expected.
It is not uncommon sometimes after surgical procedures in the eye that you notice the lid droops more significantly. You will notice that the fold that is usually about 8-10 mm from the lash line has a tendency to migrate superiorly to the top of the orbital area. A full medical work-up must be done to establish the cause of this condition. It can be a localized defect in the muscle, a neurological problem or a musculoskeletal problem that can be related to a systemic disease. Once these factors are fully evaluated, you must again be clear whether this is purely cosmetic or medically justifiable in order to fully appreciate and understand what results to expect.
Eyelid surgery can lead to asymmetry of the lids. It is very difficult to exactly align both lids to appear at exactly the same height. The patient who fully takes the time to understand this condition and understands what results can be obtained will be fully satisfied after surgery.
In addition, there are conditions known as entropion and ectropion. In entropion, the eyelid is in spasm and usually the lower eyelid forces the eyelashes to rub against the eye. This can be extremely uncomfortable, causing a foreign body sensation in the eye and marked epiphora or tearing of the eye. The causes of entropion can either be congenital, inflammatory or cicatricial scarring. The most common cause is called spastic and is usually precipitated by an inflammatory response. Frequently treating the inflammation will be adequate.
If not, a small surgical procedure known as a Quickert Procedure can be done. This is where the eyelid muscle is everted with three sutures. If topical medications and/or the Quickert Procedure are not adequate, then a more involved surgical procedure needs to be done. This can be quite an uncomfortable situation if not corrected.
Ectropion is a different type of problem and is one where the eyelid turns out. Therefore, the punctum of the eye, or the drain of the eye, is not in apposition to the eye and the tears will run down the face. This is a very uncomfortable situation and usually needs to be corrected surgically, if it is significant. These conditions are both due to a laxity of the eyelid muscle, usually in the lower eyelid.
Again, medical means of treating all these conditions are the first line of therapy and surgery becomes the last line of therapy. Before electing to have surgery done, it is important to fully understand the risks, alternatives, complications and probable results.