Upper lid malposition of the eyelid
As far as upper lid malposition of the eyelid is concerned, there are two main conditions: droopiness of the eyelid; or the top eyelid is excessively high – in other words, the eye is too widely open. Of those conditions, the droopiness is the much more common problem.
Droopiness can be due to one of two things, or even a combination of both. It’s either because the whole eyelid has dropped, because the muscle that lifts the eyelid up is not doing its job fully, or you’ve got too much skin in the top eyelid and the skin has become loose. In the latter, the skin tends to form a fold that comes forward, which gives the eye a droopy appearance.
In some cases, you can have a situation where both are occurring and the whole eyelid is drooping, but on top of that you’ve got this extra fold of skin because it’s all got a bit soft and loose. In terms of symptoms, the most common ones people experience are a heaviness, or a reduction in their vision. The third thing is how it looks; usually someone will be concerned by at least one of those three aspects, with the heaviness being the most common.
Normally, these problems occur in the more elderly group, where the skin is getting thinner and looser. There are situations where children can get droopy eyelids: i.e. ptosis. That’s the drooping of the whole eyelid, but it’s nearly always a condition which affects adults.
Sometimes it can be brought about by wearing contact lenses; sometimes there are rarer reasons why the lid can drop, which will need to be looked into. It’s worth pointing out that on the NHS these problems are considered cosmetic; it can be quite difficult, therefore, to get treatment on the NHS, even though the issue can interfere with a patient’s vision. That can be a reason why people want to have their eyes looked at privately.
The patient will come to the clinic and we’ll assess the symptoms; we’ll have a look at the eye and try to discover what is amiss with the top eyelids. Excessively open ones, for example from thyroid problems, are a much less common problem and we won’t discuss these any further here.
We can usually make a diagnosis in the clinic and plan what to do about it. The plan usually comes down to either taking away the spare skin or we need to lift the whole eyelid up, or sometimes a combination.
We can take away the skin with a treatment called blepharoplasty. That might be all that is needed. In a lot of patients, particularly in dare I say it, middle-aged ladies, the skin may be getting looser and they don’t like the look, which means a procedure can be performed for aesthetic reasons.
The second treatment option is to lift the whole eyelid up, which is called ptosis correction procedure. That is a slightly different technique; it involves tightening the muscle and lifting the eyelid up. Not many people do it, but I’m one of those who does.
We can also combine the two treatments; we can take away the spare skin while combining the ptosis correction procedure. But whatever treatment we opt for, it’s nearly always done with a local anaesthetic as a day case.
It does involve going to theatre, and after you’ve had your treatment, you’ll usually have some pads put on your eyes and you will go home with some eye drops and ointment to use.
Healing is usually quite quick. The patient may expect bruising, swelling and discomfort. If it’s a blepharoplasty, there may well be some sutures – stitches in the top eyelid – that need to be removed, too.