Drooping eyelids
Drooping Eyelids
A number of conditions have been loosely grouped under this heading and they involve both the upper and lower lids.
Excess eyelid skin (Dermatochalasis):Â In the upper lids the problem may be due to excess skin, called dermatochalasis. More information about dermatochalasis is available by clicking the green bar below.
What is it?
Excess skin in the upper lids is called dermatochalasis. It may be a cosmetic concern, but it may also cause functional problems by interfering with the top part of the vision. We need extra skin in the upper lids to allow the lids to close effectively but when this becomes excessive it may cause symptoms.
What causes it?
Dermatochalasis becomes more common as we get older and is caused by damage to the structural components in the skin. The skin loses volume and elasticity causing it to stretch. Although it is largely caused by ageing there are other factors that may contribute, including a high body mass index and smoking.
Do I have it?
When the eye is closed the upper lid skin extends between the brow and the lower lid. When the eye is open the same amount of skin needs to fit into a smaller space and it does this by forming a fold of skin in front of the top lid. This skin fold is therefore not only normal, but essential in allowing the top lid to close normally. If the amount of extra skin increases too much it will cause the fold to extend over the lashes and it may interfere with the vision. Symptoms include a sensation of hooding which blocks the vision, difficulty keeping the eyes open when reading, burning, itching and watering. If the eye is prone to watering the tears may track along the fold and result in a breakdown of the skin in the outer corner of the eye.
How is it treated?
Treatment is surgical and involves removal of the excess skin. This is done under local anaesthetic with sedation. The procedure is safe and effective with a recovery time of less than 2 weeks, although most of the swelling and bruising has usually resolved within a week, which is when the stiches are removed.
What is it?
Ptosis is caused by a failure of the system that lifts the upper lid. The firm part of the upper lid (tarsus) is connected to a muscle that contracts to lift it and relaxes when it is lowered. If there is a problem with the muscle it will be unable to lift the lid effectively, resulting in a droopy upper lid. There is a tendon between the muscle and the lid and if this tendon stretches or becomes disconnected it will also result in a droopy lid. (It is very different from dermatochalasis that is caused by excess skin in the upper lid as described above. The treatment is also very different. These conditions are occasionally confused or used synonymously because the appearance of the eye may be similar.)Do I have it?
People with ptosis will frequently have their eyebrows raisedto help lift the upper lids. In some cases, they may also tilt their heads back. The lower edge of the top eyelid lies in front of or very close to the pupil. The lids may tire easily when performing tasks like reading or working on the computer and frequently obstruct the view in spite of best efforts to keep the lids open.What causes it?
The most common cause is age related. The tissue that connects the muscle to the eyelid becomes weak and stretches, causing the upper lid to slip a bit further down until it interferes with the vision. There are several other causes of ptosis which are less common. These will be identified and fully explained during the examination if appropriate.How is it treated?
Treatment is surgical. The stretched tendon needs to be tucked back onto the eyelid. This is done under local anaesthetic as a day case procedure. The eyes are initially padded after surgery and the pads are removed within 24 hours. An antibiotic ointment is applied to the lids for 5 days. The stiches are removed after 7 days, by which time most of the bruising and swelling has resolved.What is it?
Lid laxity is a process that becomes more prevalent as we age. It can happen to the upper or lower eyelids but is more obvious and more frequent in the lower lids. In most cases the lid position does not alter significantly but occasionally the lower lid margin will rotate.
Rotation towards the eye is called entropion.
Rotation away from the eye is called ectropion.
In both entropion and ectropion, the lash follicles maintain their normal orientation relative to the lid margin. However, the lid itself has rotated and the lashes have rotated with it. The problem area is the lid itself and this is what requires treatment.
Do I have it?
Entropion is usually quite uncomfortable. Symptoms include irritation, grittiness, redness, watering and pain.
Ectropion may result in redness, watering and irritation but is often reasonably well tolerated. The appearance, however, is more obvious when the lower lid rotates away from the eye because the mucous membrane that lines the eyelids (and eyeball), called the conjunctiva, becomes red and inflamed.
What causes it?
Lid laxity is usually age related but occasionally there is an underlying medical condition that weakens the structural components of the skin and joints. The lids are attached, at the inner and outer corner, to the bones of the eye socket by means of a small tendon. This provides support and tension to the eyelid, like a hammock strung between two trees. With time the tendons may become weak and stretched, resulting in lower lid laxity.
How is it treated?
Treatment of lid laxity is surgical. The outer corner of the lid is reattached to the bone in the eye socket (orbit). The increased tension in the lower lid reduces the tendency for the lid to rotate. Depending on the underlying problem and how long it has been present there may be additional issues that require attention.
Ectropion may be associated with a shortage of skin in the lower lid. If this is not addressed the ectropion is likely to recur soon after the operation. The additional skin is taken from the skin fold in the upper lid (see dermatochalasis) and the procedure is known as a skin graft. When the new skin is stitched into the lower lid it will gradually connect to the blood supply of the lower lid.
Skin in the upper and lower lid is very similar and within a few months the graft may not be discernible from the surrounding skin.