The aging eye: when to worry about eye, eyelid problems

Unhappy with the appearance of your eyelids? When to worry, what to do

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The Aging Eye: Preventing and treating eye disease
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Age, some diseases, and certain cosmetic treatments can affect the muscles and skin of the upper and lower eyelids. Often the problem is simply cosmetic. But sometimes it may interfere with vision or irritate the eyes. Here are some examples.

Ptosis. Over time, the upper eyelids may start to sag as muscles lose their strength. This sagging is called ptosis. Eye injuries, neurologic problems, and diseases such as diabetes or the neuromuscular disorder myasthenia gravis can also bring on ptosis. 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).

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. It is important that you see your doctor to identify the underlying cause. Ptosis resulting from disease usually responds to treatment of that condition.

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 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 oculoplastic specialist can determine whether this is the case.

Blepharochalasis. In a different but related condition, only 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. Blepharochalasis can 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 eyelid 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 water excessively. The constantly exposed cornea and conjunctiva may become red and irritated. In mild cases, no treatment is needed except the regular use of over-the-counter artificial tears. some people need to use 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.

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, watery eyes, and blurred vision. 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. If not, a surgeon can correct this disorder with a relatively simple surgical procedure.

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