Eyelid Problems - Other Common Eye Diseases Of Later Life: Eye Care

Content provided by the Faculty of the Harvard Medical School

Eyelid problems

Age, certain diseases, and certain cosmetic treatments can affect the muscles and skin of the upper and lower eyelids in several ways. Often the problem is simply cosmetic, but in other cases it may interfere with vision or cause eye irritation, leading to watery eyes and other difficulties.

Ptosis. Like other parts of the anatomy that respond more to gravity over time, the upper eyelids may start to sag as muscles lose their strength. Eye injury, neurologic problems, and disease (such as diabetes or the neuromuscular disorder myasthenia gravis) can also bring on this condition. One popular cosmetic procedure, Botox injections to eliminate wrinkles at the brow and forehead, may also cause temporary drooping (although the problem can last as long as three months, so it may not feel temporary to the person affected).

Although drooping of the upper lid often is a cosmetic concern, it can interfere with sight if the lid is so lax that it covers or partially covers the pupil. Before trying any treatment, you will need a medical exam to identify the underlying cause. Ptosis resulting from disease usually responds to treatment of the disease. If the problem is caused by Botox injections, it's best to wait until the injections wear off, in about three to four months. However, if a droopy eyelid is unattractive or interferes with vision and is not caused by a treatable disease, you may want to consider surgical repair.

The ptosis repair procedure removes excess tissue and lifts the lid. It can be performed under local or general anesthesia on an outpatient basis. Many health insurers will cover this operation only if the ptosis is affecting your vision. Your ophthalmologist or ocuplastic specialist can determine whether this is the case.

Blepharochalasis. In a different but related condition, just the skin of the lid begins to droop, not the entire lid as in ptosis. This happens when the skin loses elasticity and sags, creating new skin folds that can actually droop over the lashes and block the upper field of sight by covering the pupil. This condition, blepharochalasis, may be surgically corrected with a procedure called blepharoplasty. As with ptosis, most health insurers will pay for this repair only if your condition interferes with vision.

Ectropion. This condition occurs when the lower lid sags and turns outward. The muscles of the lower lid weaken, and the lid no longer comes in contact with the eyeball. As a result, the margin of the lid may thicken, the upper and lower lids no longer meet when the eye is closed, and the eye may tear excessively. The constantly exposed cornea and conjunctiva may become red and irritated. Ectropion may involve one or both eyes.

In mild cases, no treatment is needed except the regular use of artificial tears, which may be purchased over the counter, and perhaps the use of a plastic eye shield at night to help retain moisture. If the symptoms or appearance are more bothersome, surgery designed to tighten the lower eyelid and surrounding muscles can correct it. The goal of the procedure is to secure the lower lid so that it rests more closely against the eyeball. After the surgery, you may need to wear an eye patch and apply antibiotic ointment for a few days.

Entropion. In this condition, the lower lid rolls in, toward the eye. Because the lashes constantly rub against the cornea, entropion may produce irritation, a feeling of something in the eye, tearing, and blurring. This disorder can be corrected with a relatively simple surgical procedure. Sometimes, in mild cases, it helps to tape the lower lid to the cheek every night so the edge of the lid and the lashes are in the proper position. Ask your doctor if this approach might work for you and how to do it properly.

Skin cancer. Although skin cancer can occur anywhere on the body, when it affects the eyelids, it is wise to consult an ocuplastic specialist about treatment in order to preserve vision while achieving the best cosmetic results. The most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. Although each type has its own telltale signs, the safest strategy is to periodically examine your eyelids for any unusual growths that change color or shape, and alert your ophthalmologist if you notice anything unusual. The doctor can then examine the lesion and decide whether it should be biopsied. If a lesion proves to be cancerous, an ocuplastic surgeon will remove it and reconstruct the eyelid as necessary.

Last updated:	June 19, 2007