Droopy Eyelids

Droopy eyelids are a major reason why some people contemplate eyelid surgery (blepharoplasty). Blepharoplasty removes and tightens sagging eyelid skin for a more alert, youthful appearance.

Blepharoplasty can also improve vision by removing any obstruction to vision caused by the droopy eyelids, such a procedure is called functional blepharoplasty and is not considered cosmetic surgery.

An upper eyelid blepharoplasty (sometimes called an "eye lift") should not be confused with upper eyelid ptosis surgery, which is a procedure to raise the position of the upper eyelid margin by tightening the muscle and tendon that normally elevate the upper lid. Differentiating between both procedures requires assessment by your eye doctor.

However, before blepharoplasty is performed, it is important to exclude other important ophthalmic causes of droopy eyelids.

What are the causes of droopy eyelids?

The most common cause is senile ptosis, a condition of droopy eyelids as a result of ageing. The elevator muscle of the upper eyelid weakens and eventually tears with ageing, resulting in a difficulty with opening the eyes as well as subconscious and inadvertent usage of the forehead muscles to assist in eyelid elevation.

Droopy eyelids may be the first sign of myasthenia gravis, a condition where muscles become weak and tire easily.

Acute onset, unilateral lid drooping may signal a neurologic condition, and is an ophthalmic emergency, requiring immediate evaluation.

Droopy eyelids, if the onset occurred in early childhood, is congenital in nature. Congenital droopy eyelids occur as a result of maldevelopment of the muscle which elevates the upper eyelid.

What are the symptoms of droopy eyelids?

These include difficulty keeping the eyes open, eye fatigue, eyebrow aches from having to use the brow muscles to help lift the upper lid. In severe cases, an abnormal head position such as a chin lift may be needed to look out from underneath the droopy eyelids.

Treatment of droopy eyelids

Droopy eyelids is treated surgically. The specific surgery is dependent on the severity of drooping and the strength of the eyelid elevator muscle. Droopy eyelid surgery can often be done via the same incision that would be used for double eyelid creation, or via a pre-existing double eyelid crease.

This can either be in the form of:

• tightening the eyelid elevator to elevate the eyelid to the desired position, or
• using a “sling” to enable the forehead muscles to elevate the eyelid in cases of severe eyelid droopiness

Children with droopy eyelids should be followed up closely, as they can develop lazy eye (“amblyopia”) as well as refractive error (eg: astigmatism) as a sequelae of the droopy eyelids.

Surgery is usually performed as an outpatient procedure, under local anaesthesia with the patient lightly sedated. With younger children, general anaesthesia is preferred. No overnight hospital stays are required.