Droopy Eyelids Among the Elderly: Is it Worth Getting Surgery?
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Droopy Eyelids Among the Elderly: Is it Worth Getting Surgery?

Eyelids do a great job of framing our eyes and giving them a beautiful shape. The eyelids are thin flaps of muscles and skin that provide coverage to the eye. These flaps deteriorate with time and lose their tautness leading to drooping in old age.

Droopy eyelids are most apparent among the senile members of society, and most often, the functional and aesthetic concerns may turn people in a search for droopy eyelid treatments.

Eyelid drooping can happen on the eyelids and it can be the conditions below:

  1. Ptosis: This is the sagging of upper eyelids and is a common cause of drooping.
  2. Blepharochalasis is the condition where upper eyelid skin loses elasticity due to swelling or inflammation and therefore it sags. It is associated with Ptosis.

Ptosis: When the Upper Eyelid Droops

ptosis MRD diagram

No age group is defined for the occurrence of ptosis. But most evidently it is seen in the elderly group whose muscles start to deteriorate.
In the medical world, drooping or falling of the upper eyelid is termed as Ptosis. Ptosis most commonly occurs due to the malfunctioning of the muscles of the eyelids or disturbances in the nerve supply of the muscles. Ptosis may affect one eye or both eyes.

Types of Droopy Eyelids 

There are 2 major types of droopy eyelids (ptosis):

  1. Congenital ptosis: refers to ptosis present at the time of birth.
  2. Acquired ptosis: occurs when structures of the upper eyelid are unable to maintain normal function

Acquired ptosis is further subclassified into 5 types based on etiological factors:

  1. Aponeurotic ptosis is most prevalent in elderly patients.
  2. Disruption in the innervation of Muller’s muscle or levator muscle results in the 2nd type of ptosis termed as neurogenic ptosis.
  3. Myogenic ptosis is caused by issues in the levator muscles itself.
  4. Traumatic ptosis is followed by direct or indirect trauma to the levator muscle.
  5. Mechanical ptosis Any tumor that increases the weight on eyelids or scarring can result in mechanical ptosis.

Causes of Ptosis in Elders

No definitive cause for ptosis is known. Though different causes are suspected.

  • Aging. As age increases abnormalities arise in nerves that supply the levator muscles.
  • Trauma to the eye or lesions of the lid is also a factor for ptosis in elderly patients.
  • Autoimmune disease. Dysfunctions of levator muscles that elevate the eyelid may be associated with autoimmune diseases. Myasthenia gravis is a devastating autoimmune disease that affects muscles or causes nerve damage.
  • Drug intake in old age. Ptosis may also appear due to drug intake for certain nervous system issues like a superior cervical sympathetic ganglion. As age increases, older people are more exposed to drugs for different ailments. Drugs such as pregabalin are known to cause ptosis.

Signs and Symptoms of Senile Ptosis

Signs and symptoms that are observed among elders are as follows:

  • Patients appear tired due to drooping lids
  • Dryness of eyes
  • Poor vision
  • Aching of eyes
  • Difficulty in the blinking of eyes
  • Tearing of eyes may also occur
  • Double vision may appear

Factors Leading to Ptosis

Many factors make an old age person prone to Ptosis. These include:

  • Excessive and aggressive eye rubbing
  • Prolonged use of contact lenses
  • Horner’s syndrome
  • Myasthenia gravis

Inconveniences and Dangers due to Ptosis

Every medical condition causes inconvenience to the patient. Ptosis may seem a relatively smaller concern compared to other health conditions. But like every health issue, it has its own inconveniences and one has to adapt accordingly. The dangers and inconveniences due to ptosis are:

  • Frequent falling due to impaired vision.
  • Due to the sagging of eyelids. One has to tilt his head back to adapt to the situation.
  • Extra effort is required for viewing. One has to constantly lift eyebrows to see things properly.
  • Old people are low on energy. So, a lethargic feeling is a likely outcome of forceful opening (of eyes).
  • Dryness of eyes may occur that can lead to increased irritation and wear and tear. Therefore, patients have to use lubricants. This is one of the reasons that prompt patients to get treatment for droopy eyelids.

When to See a Doctor for Droopy Eyelid Treatment

visual field test

The disease affects different people at different levels. Some elders may not experience any obstacles in normal viewing while others face inconveniences.

People without functional issues can still get ptosis treatment done for aesthetic reasons, while those with visual impairment should seek medical treatment before worsening the issue. If you are an active oldie and are now facing difficulties while driving, reading, and even walking, then you should consult a doctor right away. Ptosis has both aesthetic and functional concerns.

Droopy Eyelid Treatment Options: Non-Surgical Vs. Surgical 

Saggy eyelids are problematic both in looks and in function. The ladies tend to stay young as long as they could but the saggy, wrinkled skin around the eyes, and the hollowness around the eye area impart an older look (which in most cases is unbearable).

Conclusive and effective treatment is surgical intervention. But the question now arises is that is it worth getting surgery for droopy eyelids?

Non-Surgical Droopy Eyelid Treatment

For starters, we will be showing you the non-surgical droopy eyelid treatments you can consider.

Yes, there are a few non-surgical methods by which you can get your droopy eyelid back to its fit and taut form and visualize the world like the golden old days.

  • Botulinum Toxin Injection. Botulinum toxin when used on selected muscle groups around the eye can help to lift the eyelids. Although it can help to refresh your look, results are temporary, and the treatment will need to be repeated 5 to 6 months later. Additional touches of Botox injection can also soften crow’s feet for forehead wrinkles for a fresher and more youthful look.
  • Injectable Fillers. Ladies who are conscious about their looks and denounce the growing age can get fillers to volumize their upper eyelid area. The injectable fillers produce volume to plump the crevices of the eyelids. This is more of a cosmetic treatment than functional and is intended only for the beauty-conscious lot.

Surgical Droopy Eyelid Treatment: Ptosis Correction Surgery

Treatment of Ptosis depends upon the severity of the condition and treatment depends on the severity of the droopy eyelid condition.

Ptosis Correction Surgery is an eyelift surgery. In this surgery, levator muscles are tightened so the upper eyelids can be raised higher. In some cases, the extra fat, tissue, and skin are removed to decrease the weight on the eyelid.

The surgical procedure can be performed using 2 techniques which are given below:

  1. Non-Incisional Method

non incision ptosis correction

In this method, the muscle length of the eyelid is reduced. This is achieved by tying a portion of the eyelid muscle with the help of a suture. This suturing action results in the tightening of the eyelids and allows a raised position of the eyelid when opened.

  1. Incisional Method

incisional ptosis correction

This is the method of choice in more severe cases where extensively stretched and lengthened eyelid muscles are trimmed short and pinned upwards. The muscles are incised and tied higher, so they remain in a higher position when opened.

Complications and Risks Associated with Surgery at Old Age

There are some risks and complications associated with the surgery. You may experience some discomfort after surgery. The recovery time may be delayed owing to the old age of the patients. Normal activity can be resumed within 7-10 days, but it is preferable to take rest for minimally two weeks.

  • Bruises and Swelling. Bruising and swelling can be seen post-operation but they subside within 10 days. Should it take longer to subside, a natural supplement can be prescribed to help with bruising and swelling management.
  • Wound Dehiscence and Infection. Wound dehiscence is another possible complication of surgery. The body’s decreased inflammatory response with age or certain underlying health conditions may increase the chance of wound dehiscence and infection.
  • Scar Formation. Eyelid healing may result in scar formation that takes longer to subside. Although it is not a threat to the person’s health, it can still be problematic for the elders. Topical medication and laser treatments can help to improve the appearance of scarring. Therefore, these options may be recommended during or after full recovery.
  • Eyelid Overcorrection. Droopy Eyelid Correction may result in the excessive opening of the eye. If this happens, a correction procedure can be done to adjust the height of the eyelids.
  • General health may also be compromised in very old patients as a result of surgery. Most old patients tend to be physically weaker and may be taking different drugs for different conditions. Certain pre-existing health conditions may post challenges to the surgery planning as well. Anesthesia may also have negative impacts for elderlies with certain types of health condition too.

Get a droopy eyelid assessment to understand more

The greatest benefit of getting surgery for droopy eyelids is enhanced vision. Old age patients commonly acquire injuries from falling. The frequent falling is sometimes attributed to poor eyesight and a lack of muscle coordination and surgical correction can reduce the frequency of falls in old patients.

A proper droopy eyelid assessment by a plastic surgeon can help to determine if surgical intervention is necessary and suitable for your loved ones.