Dr Babak Babsharif, Ophthalmologist, Subspeciality in Cosmetic Eye Surgeries (Oculoplastics), & Strabismus
Member of American Academy of Ophthalmology (AAO)
Member of European Society of Cataract & Refractive Surgery (ESCRS)
Certificate of Ophthalmology from International Council of Ophthalmology (ICO) Cambridge, UK
Medical Degree 1989
Board of Ophthalmology 1997
Subspeciality Degree 2006
Complementary Education in University of Texas, USA
Droopy eyes refers to drooping of an upper eyelid of one or both eyes. The droop may be barely noticeable, or the lid can descend over the entire pupil. Droopy eyelids can affect both children and adults. In children, it usually occurs before birth, but in adults, the condition usually occurs because of aging. If excess skin of the upper eyelids hangs down to cause visual problems, the condition is called dermatochalasis. If the eyelid itself falls, the condition is called ptosis.
Ptosis is an abnormally low position (drooping) of the upper eyelid and occurs when the muscles that raise the eyelid (levator and Muller's muscles) are not strong enough to do so properly. It can affect one eye or both eyes and is more common in the elderly, as muscles in the eyelids may begin to deteriorate. The drooping may also be worse after being awake longer, when the eyelid muscles are tired. If severe enough and left untreated, the drooping eyelid can cause other conditions, such as amblyopia or astigmatism. Ptosis can also be congenital, and results from an abnormal formation of the muscle. This leaves the eyelid without normal lifting power.
The workup for ptosis involves taking eyelid photographs, obtaining measurements of the eyelid position, and a visual field test to determine how much peripheral vision is affected by ptosis. Most insurance companies require this information to qualify the condition for payment. Occasionally, other testing may be required if other medical conditions are being considered as a cause for ptosis.
If an underlying medical condition causing ptosis is found, the treatment will be specific to that disease. Most cases of ptosis are associated with aging and there is no disease involved. Surgery can be done to improve the appearance of the eyelids in milder cases if the patient wants it. In more severe cases, surgery may be necessary to correct interference with vision. In children with ptosis, surgery may be necessary to prevent amblyopia (lazy eye). Surgical treatment for children may involve surgery directly on the muscle, or by attaching the eyelid to the eyebrow (frontalis suspension).
Redundant and lax eyelid skin and muscle are known as dermatochalasis. Dermatochalasis is a common finding seen in elderly persons and occasionally in young adults. Gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid frequently contribute to this lax and redundant eyelid tissue. These findings are more common in the upper eyelids but can be seen in the lower eyelids as well. Genetic factors and family traits may play a role in some patients.
Dermatochalasis can be a functional or cosmetic problem for the patients. When functional, dermatochalasis frequently obstructs the superior visual field. In addition, patients may note ocular irritation, entropion (turned in position) of the upper eyelid, ectropion (turned out position) of the lower eyelid, eyelash infection, and dermatitis. When cosmetic, patients note a fullness or heaviness of the upper eyelids, "bags" in the lower eyelids, and wrinkles in the lower eyelids and the lateral canthus, both of which contribute to an aged appearance.
The most common visual difficulties encountered include loss of the superior visual field, difficulty in reading, and loss of peripheral vision when driving. In addition, patients with moderate-to-severe dermatochalasis chronically elevate their brows to improve their visual field. This frequently is associated with frontal headaches. Ocular irritation, dry eyes, and dermatitis also may be the presenting signs of dermatochalasis.
The treatment of dermatochalasis usually involves surgery, either cosmetic or functional (medically necessary). If the droopy eyelids block more than 20 – 25 % of the peripheral vision, insurance may pay for the surgery. Medical therapy may be helpful, and involves eye drops or eye ointment to reduce infection, skin irritation, and dry eye problems that may occurs with droopy eyelids. Surgical care involves an office procedure or outpatient surgery. The excess skin is measured and removed, with care taken to avoid removing too much skin. Occasionally, removal of excess fatty tissue may be involved, and this helps improve the contour and appearance of the eyelids.
Bags under eyes — mild swelling or puffiness under the eyes — are common as you age. With aging, the tissues around your eyes, including some of the muscles supporting your eyelids, weaken. Normal fat that helps support the eyes can then move into the lower eyelids, causing the lids to appear puffy. Fluid also may accumulate in the space below your eyes, adding to the swelling.
Bags under eyes are usually a cosmetic concern and rarely a sign of a serious underlying medical condition. At-home remedies, such as cool compresses, can help improve the appearance of bags under eyes. For persistent or bothersome under-eye puffiness, cosmetic treatments are available.
Bags under eyes can include:
Saggy or loose skin
When to see a doctor
You may not like the way they look, but bags under eyes are usually harmless and don't require medical care. See your doctor if the swelling:
Is severe and persistent
Is accompanied by redness, itching or pain
Affects other parts of your body, such as your legs
Your doctor will want to rule out other possible causes that can contribute to the swelling, such as thyroid disease, infection or an allergy.
As you age, the tissue structures and muscles supporting your eyelids weaken. The skin may start to sag, and fat that is normally confined to the area around the eye (orbit) can move into the area below your eyes. Also, the space below your eyes can accumulate fluid, making the under-eye area appear puffy or swollen. Several factors can lead to this, including:
Fluid retention due to changes in weather (for example, hot, humid days), hormone levels or eating salty foods
Not getting enough sleep
Allergies or dermatitis, especially if puffiness is accompanied by redness and itching
Heredity — under-eye bags can run in families
Bags under eyes are usually a cosmetic concern and don't require specific treatment. Home and lifestyle treatments may help reduce or eliminate puffy eyes.
Medical and surgical treatments are available if you're concerned about the appearance of under-eye swelling. Treatment may not be covered by medical insurance if it's done solely to improve your appearance.
If you think the swelling under your eyes is caused by an allergy, ask your doctor about prescription allergy medications.
Various wrinkle treatments are used to improve the appearance of puffiness under the eyes. These include laser resurfacing, chemical peels and fillers, which may improve skin tone, tighten the skin and rejuvenate the look of bags under the eyes.
Eyelid surgery (blepharoplasty) is an option to remove bags under eyes. During blepharoplasty (BLEF-uh-roe-plas-tee), the surgeon cuts just below the lashes in your eye's natural crease or inside the lower lid. The surgeon removes or redistributes excess fat, muscle and sagging skin. He or she then rejoins the skin with tiny dissolving stitches along the lid's natural crease or inside the lower eyelid. The procedure is usually done as an outpatient procedure.
In addition to correcting bags under eyes, blepharoplasty can also repair:
Baggy or puffy upper eyelids
Excess skin of the upper eyelid that interferes with your vision
Droopy lower eyelids, which may cause white to show below the iris — the colored part of the eye
Excess skin on lower eyelids
Talk with your doctor about the risks of eyelid surgery, which include infection, dry eyes, and problems with vision, tear ducts and eyelid position
Lifestyle and home remedies
The following tips can help you reduce or eliminate bags under eyes:
Use a cool compress. Wet a clean washcloth with cool water. While sitting up, apply the damp washcloth to the skin under and around your eyes for a few minutes using mild pressure.
Get enough sleep at night. For most adults, seven to eight hours a night is a good amount of sleep.
Sleep with your head slightly raised. Add an extra pillow or prop up the head of your mattress. Or elevate the entire head of the bed a few inches. This helps prevent fluids from accumulating around your eyes as you sleep.
Reduce allergy symptoms. Avoid allergens when possible. Try over-the-counter allergy medications. Talk to your doctor about prevention strategies if you develop under-eye reactions due to hair dyes, soaps, cosmetics or other allergens.