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Upper eyelid blepharoplasty in elderly people

Today I had a patient sitting in the clinic with me. It was her two-month post-op upper eyelid surgery visit and hence her last visit with me.
We looked back at her original photos which showed enormous hangdog drooping of her upper eyelids with lateral hooding. She did not have any upper lid show, and the lashes were completely concealed by the soft tissue of her upper lids i.e. the skin and fat just hiding the lashes and obscuring the vision. This was making her vision enough dark and interfering with her visual field.
Today her comments were that she could see “so much more light” and that the surgery had “really lightened her vision”. Everything was much brighter because more light was getting in and also she did not have to lean her head backwards to look up because there was no longer this eyelid curtain draped down across her vision. She was delighted with the result.
We do not often think about people’s vision being improved by eyelid surgery. We all know that when you have a cataract operation and when the eye pad comes off the patient often says “oh, this is fantastic. I can see so well, everything looks so bright and the colours so much sharper!” However, when people have eyelid surgery, this also can have a very beneficial effect on the quality of their vision and hence the quality of their life.
A recent paper in the International Journal of Ophthalmology 2016, Volume 9; p1320-1324, looked at the effects of upper eyelid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis. Lash ptosis means when the lashes are pointing downwards, and dermatochalasis means when there are too much skin and soft tissue such as fat in the upper eyelids. They looked at 39 patients and 73 eyelids, who had upper eyelid blepharoplasty.
They looked at the quality of their vision from measuring the visual acuities, their contrast sensitivity (how well they saw the sharpness of black and white and colours), and then measured the vertical palpable aperture which means the opening of the eyes and the amount of lash ptosis. They found a significant increase in the quality of the patient’s contrast sensitivity after surgery, as well as improvement of the degree of lash ptosis which considerably decreased, and they had much better vision. So even scientifically we can show that image improves after upper eyelid blepharoplasty.
Upper eyelids often droop, and the eyelashes become ptotic with age. The correction of this sagging upper eyelid skin can be achieved by excising the redundant skin as an operation called blepharoplasty. The above study by Seung Hyun et al. from Busan in Korea has clearly shown the advantages of having upper eyelid surgery. They write in their paper: “after upper eyelid blepharoplasty patients may experience brightening of vision, thus upper lid blepharoplasty could help to improve visual quality.” I thoroughly agree with them; it supports exactly what my patient said to me in her last consultation with me today.
In summary, in older people, if they what to see better, it may not just be cataracts and cataract surgery that can help them, but also removing the excess upper eyelid tissue which is getting in the way of the vision and affecting the contrast sensitivity or brightness of their vision that matters.

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