The following ageing changes around the upper lid often prompt patients to seek remedial treatments
- Excess upper eyelid skin that causes heaviness and eyelid hooding
- The eyelid can droop due to weakness, also called eyelid ptosis
- The eyelid can move up (eyelid retraction)
- The eyelid muscle may be weak or scarred and eyelid closure may be incomplete risking damage to the eye
- There may be excessive upper eyelid fullness due to bulging fat or upper eyelids hollow and sunken eyelids due to loss of fat.
- Absent or a very high eyelid crease or an asymmetric eyelid crease.
- Uneven eyelids
What causes droopy upper eyelids?
The eyelids are delicate and complex structures that can be affected by a variety of conditions. There are many causes of eyelid drooping or acquired ptosis.
The commonest cause of droopy eyelids
- Overstretching and disinsertion of the muscle and the tendon that opens the upper eyelid due to age related changes
Other causes include
- Eyelid growth, tumours or swelling
- Muscular and neurological problems
- Nerve damage in the eye muscles.
- Trauma to the eyelid structures including nerve injury
- As a complication of Botox injections.
Why do patients complain that their upper eyelids become heavy?
Eyelids become fatigued due to over activity of the eyelid muscle resulting in a feeling of heaviness. Nowadays overuse is related to long hours of focusing on a computer screen, tablet or a smart phone. It is estimated that on average people spend in excess of 8 hours per day in front of a screen. When you are young, your eyelid muscle and the surrounding tissues cope better with prolonged strain,
However, as you get older features such as excess eyelid skin, excess fat and droopy brow add additional weight on the upper eyelid exaggerating the sensation of ‘eyelid heaviness’. This is frequently accompanied by frontal headaches due to the constant activity of the forehead muscle.
Patients with hooded eyelids, droopy or weak eyelids may have these symptoms
- Headaches, particularly tension headaches in the forehead area especially at the end of the day.
- Neck pain due to straining
- A feeling of eyelid heaviness at the end of the day despite the routine use of glasses.
- Smudging of eyeshadow due to overhang of excess skin
- Negative social comments such as "you look tired", ‘you look stressed” ‘you look sleepy”.
What does the clinical examination of patients with hooded eyelids, droopy or weak eyelids reveal?
- Eyebrow elevation, high arched eyebrows or uneven eyebrows in an attempt to compensate for restricted visual fields
- Overhanging excess skin on the upper eyelids touching the eyelashes or hooding making the eyelids weak or droopy looking
- A hollow look in the eye socket, due to loss of fat.
- Tired and sleep look due to droopy or weak eyelids
- Fat bulges in the upper eyelid and loose excess and crepey skin.
- Reduced eyeshadow space.
- Uneven or asymmetric eyes
- Uneven of asymmetric eyelid crease
Patients with hooded eyelids, droopy or weak eyelids have these practical concerns that they are unaware of being caused by the eyelids
- Vision is bad despite wearing reading glasses.
- Difficulty reading in dim light situations such as early morning or late in the evening.
- Difficulty driving at night
- Restaurant menus are hard to read often requiring a bright source of light like a torch on your smart phone.
- Occasionally run into objects because you did not see them coming.
- When you wake up in the middle of the night, you struggle to see as everything is pitch black.
