Drooping eyelids are called ptotic eyelids. Eyelid ptosis in adults is usually a result of ageing that affects the muscles in the eyelid. These muscles are are designed to lift the upper eyelid. Eyelid ptosis in children can be due to weak muscles that make the eyelid drop.
Eye bags refer to an excess of eyelid tissue which can affect the upper and lower eyelids with age. Not only can eye bags look unsightly but they can also impair vision. A chalazion (also known as meibomian cyst) appears as a lump on the eyelid. A chalazion is a common condition; it is benign and easily recognised and diagnosed.
Types of eyelid conditions
- Drooping Eyelids (Eyelid Ptosis)
- Eye Bags
- Eyelid Lumps and cysts
Causes of eyelid conditions
Eyelid ptosis is usually a result of ageing. But it can also occur in younger adult patients, especially those who wear contact lenses, due to a continuous micro trauma from insertion and removal of the lenses.
In rare cases eyelid ptosis can be related to a neuromuscular disease. Eyelid ptosis can also occur with the use of some drugs, following eyelid trauma or with the extra weight of an eyelid lump such as a large chalazion or tumour.
Eyelid ptosis in children is usually due to a congenitally fatty muscle that lifts the lids – as a result the muscle is not strong enough and the eyelid droops. If not treated promptly, the condition can result in permanent visual impairment.
Examination for eyelid conditions
For drooping eyelids and eye bags we perform a full ophthalmic examination to check visual function. For drooping eyelids eye movement, we check the eyelid condition and the ocular surface. Then we perform a full face examination and commonly take photographs.
We take special eyelid measurements and perform a phenylephrine test to assess the degree and type of ptosis. This helps us decide the specific surgery that you may require.
We assess the surface of the eye and the lids using a slit lamp to check for signs of dryness. We may use drops to dilate the pupil. Occasionally, we may order a visual field test if there are vision problems.
The examination for eye bags excludes eyelid and eye surface conditions such as blepharitis, dry eye, eyelid laxity or any other conditions that could be exacerbated by a blepharoplasty. The patient’s entire face and eyelids are examined during the consultation.
We will ask the patient how the eye bags affect them, determine whether the problem is cosmetic or also affects vision. It is also useful for the patient to provide photographs taken prior to the eye bags becoming noticeable, for instance from two to five years younger, to aid in understanding the individual cases and to plan their blepharoplasty.
For eyelid lumps and cysts, we examine eyelids both macroscopically (naked eye) and with magnification (slit lamp) to determine whether it is an acute or quiet chalazion, whether there is any associated blepharitis, or meibomianitis, or any other problems.
To decide whether medical or surgical treatment is required, the oculoplastic surgeon will examine the eyelid, both on its skin side and evert it to see its underside. Whilst this is being done, the eyes should be open and the patient looking down. Everting the lid does not hurt. A chalazion has a typical “grey” appearance on the underside of the eyelid which helps to confirm the diagnosis. We pay particular attention in the examination to exclude a malignant tumour. If there is any doubt, we recommend a biopsy.
More about the different types of eyelid conditions
Eyelid ptosis in adults is usually a result of ageing changes that affect the muscles that are designed to lift the upper eyelid but can also occur in younger adult patients.
Eye bags refer to an excess of eyelid tissue which can affect the upper and lower eyelids with age. Not only can eye bags look unsightly but they can also impair vision.
A Meibomian cyst appears as a lump on the eyelid. A common condition, it is benign and easily recognised and diagnosed. It can be treated either medically or surgically.
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