The aging eye: when to worry about eyelid problems

Age, certain diseases, and some cosmetic treatments can affect the muscles and skin of the upper and lower eyelids. Often the problem affects your appearance and nothing more, but in other cases it may interfere with vision or cause eye irritation.

Blepharitis. Blepharitis is inflammation of the eyelids. It can be caused by a problem with the oil glands near the base of the eyelids, a bacterial infection, or skin conditions like rosacea or seborrheic dermatitis (dandruff of the scalp and eyebrows). Though blepharitis usually doesn't affect your sight, it can make your eyelids red, itchy, and swollen and leave your eyes red and watery. Your ophthalmologist might recommend treatments like artificial tears or a short course of steroid eye drops to relieve discomfort from blepharitis. You'll also get treated for the cause of the problem, for example, with anti-dandruff shampoo or antibiotic eye drops. It also helps to regularly clean your eyelids with a warm washcloth.

Ptosis. Over time, the upper eyelids may start to sag as the muscles that support them lose their strength. Eye injury, nervous system problems, and disease (such as diabetes or myasthenia gravis) can also cause this condition. Botox injections to eliminate wrinkles in the brow and forehead may also cause drooping, which can last as long as three months.

Although upper eyelid drooping is often only 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 cause. If a disease caused your ptosis, the drooping usually improves when the disease is treated. If the problem is caused by Botox injections, it should resolve in about three to four months when the injection wears off.

If a droopy eyelid is unattractive or interferes with your 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, but only if the ptosis affects your vision. Your ophthalmologist or oculoplastic specialist can determine whether you qualify for coverage.

Blepharochalasis. When eyelid skin loses elasticity and sags, it creates new folds that can droop over the lashes and block the upper field of sight by covering the pupil. In blepharochalasis, just the skin of the lid begins to droop, not the entire lid as in ptosis (which is caused by muscle weakening). A surgical procedure called blepharoplasty can correct this condition. As with ptosis, most health insurers will pay for this repair only if the condition interferes with vision.

Ectropion. This condition occurs when the muscles of the lower lid weaken, making the lid sag and turn outward, away from the eyeball. As a result, 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. In mild cases, no treatment is needed. You can use over-the-counter artificial tears and a plastic eye shield at night to hold moisture in your eye. If the symptoms or appearance bother you, surgery can tighten the lower eyelid and surrounding muscles. After the surgery, you may need to wear an eye patch for a few hours and apply antibiotic ointment for a few days.

Entropion. In this condition the lower lid rolls inward 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. In mild cases, it can help 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 find out how to do it properly. A surgeon can also correct this disorder with a relatively simple procedure that removes a piece of your lower eyelid to tighten the skin and muscles there.

For more information about keeping your eyes healthy, read The Aging Eye, a Special Health Report from Harvard Medical School.

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