Formula Medical Group
Apple Valley, CA
760-242-1234


James Krider, MD


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Droopy eyelid

A droopy eyelid before (left) and after correction with plastic surgery.

 

A droopy eyelid before (left) and after correction with plastic surgery.

What is a droopy eyelid?

This descriptive name covers a variety of conditions in which one or both eyelids fall too far down over the eyes. The droop may be slight and may be only of cosmetic concern or it may be so severe that vision is blocked.

SYMPTOMS

  • The eyelid droops down low in front of the eye(s).
  • The lid does not rise or fall crisply as one's gaze is directed up or down.

What causes a droopy eyelid?

Some people are born with this problem due to a congenital malformation (called blepharophimosis), which may include other structural defects besides the droopy lids. Diseases that arise later in life, such as myasthenia gravis, also can cause it. Sometimes the lid simply is misshapen. In many other cases, the levator muscle, which normally holds up the eyelid, is too long or too weak, or the nerve that controls it is paralyzed. A droopy eyelid is a fairly common consequence of injuries in which the levator muscle(s) is cut or crushed. Fractures of the skull bone between the nose and eye socket also can cause the lid to droop, in some cases so far down that it completely covers the eye.

In Asians, the eyelid naturally may fall slightly lower, or seem to, than it does in Caucasians. Asians also tend not to have natural folds in the upper eyelids, as Westerners do, and the lids tend to cover the inner corner of the eyes. Many Japanese and other Asian young people seek plastic surgery to raise their lids, create folds, and expose the inner corners of the eyes, thus achieving a more Western appearance. This operation is opposed by many Asians who say it is unseemly to seek

 

cosmetic surgery that obscures one's racial traits.

Normal aging also can contribute to a drooping of the eyelids, and large numbers of eyelid operations are done to give a more youthful appearance.

How is a droopy eyelid diagnosed and treated?

The condition is self-evident. The important part of the diagnosis is to determine its cause. Most cases can be remedied by plastic surgery. If plastic surgery is not feasible, the person may be fitted with a special device that is attached to eyeglass frames and holds the eyelids open. These devices are most helpful to people who have damaged nerves.

What can I do myself?
There is no self-treatment for droopy eyelids due to medical problems or muscle weakness. Sometimes droopy eyelids are temporary and due to situations that are easily remedied, such as fatigue, allergies, or even hangovers. Make sure that you get adequate sleep. Avoid rubbing your eyes, and go easy on alcohol.

When should I see my doctor?
If one or both eyelids suddenly begin to droop for no apparent reason, then you should seek medical attention. Drooping that follows an injury should be checked immediately. For example, a person thrown against a windshield in a car accident may sustain damage of the levator muscle in an eyelid.

What will the doctor do?
He or she will examine your eyes and face and may perform a more complete physical examination. Tests and x-rays may be ordered. Your doctor should be informed of recent injuries or activities that might account for a sudden drooping of the eyelid.

 

In establishing a diagnosis, the doctor also tries to determine the source of the problem. For example: Is the muscle stretched? Has it been weakened or injured? Is there degeneration of the nerve?

These findings help determine exactly what type of surgery is required. The corrective operation probably will be performed by a facial plastic surgeon. In most cases, the surgery will be directed to shortening the levator muscle(s). In cases where the muscle is too weak to hold up the lid, however, the surgeon may suture the inner portion of the eyelid to the tissues under the eyebrow.

The course of a droopy eyelid

If the drooping is caused by an underlying illness, it may abate without treatment if that illness is cured or corrected. But congenital lid droops and those caused by injury are unlikely to improve of their own accord.

Careful surgical correction should largely or wholly correct droopy lid(s). One common complication is that the corrected eyelid lags behind the eye. Under normal conditions, the lids extend downward as a person gazes toward the ground. But if the levator muscle has been shortened too much or has been sutured behind the brow, this may be hindered.

Is a droopy eyelid dangerous?
No, unless it comes on suddenly because of a serious underlying illness or injury.

What can I do to avoid a droopy eyelid?

In most instances, you cannot prevent the drooping. Of course, the temporary droop called tired eyes can be avoided by getting adequate sleep and avoiding fatigue and over­indulgence in alcohol. Stay out of smoke-filled rooms and other situations that may cause eyestrain and fatigue.

This article was last reviewed November 23, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
 
Fractured skull bone
Myasthenia gravis


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