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‘Feels like I’m wearing blinkers!’ – upper eyelid hooding

Upper eyelid hooding is commonly but not always a cosmetic problem. There can be significant vision problems caused by this condition. A number of patients present with a sense that their vision is shaded and restricted by hooding of the upper eyelids. They often pinch the fold of skin in their upper eyelids; holding it up, out of the way, to fully appreciate the visual impairment it is causing. Most recently I’ve had a theatre nurse attend with these symptoms leading to a loss of confidence in driving and an inability to thread a needle . A 40minute local anaesthetic upper eyelid blepharoplasty relieved her of her symptoms.


Look older than you feel?

As our lifespans continue to extend we often begin to look older than we feel.

Hooding of the upper eyelids, dark circles and bags under eyes are common complaints that many of us experience from our 30s onwards. There are now many surgical and non surgical interventions that can be used to manage these problems. Sometimes the most obvious course of action is not the best. Hooding of upper eyelids may be caused by excess skin in the upper eyelids so removal of this skin may be helpful; however, the hooding may be caused by a droop or deflation of the eyebrows. In the latter scenario, a non surgical brow lift may be the answer.

What is Botox®?

Botox® is Allergan’s (a drug company) registered trademark for a form of botuliunum toxin. It has come to be synonymous for all forms of botulinum toxins in many people’s minds – much like ‘Hoover’, ‘Sellotape’ etc….

Botulinum toxin is extremely useful in managing frown lines (between the eyebrows) and crows feet (around the outer corner of the eyes). The drug can also be used to treat other muscular spasms and tics. In selected cases a brow lift can be achieved using this drug alone, reducing upper eyelid hooding without resorting to surgery.


What changes occur in ageing eyelids?

There are certain changes we can see in people’s eyelids/brows as they age. Your Oculoplastic surgeon will be able to identify these when considering treatment of age related conditions or in planning periocular rejuvenation.

Loss of volume:

As we get older we see the ‘plumpness’ of our features diminish. With regard to the periocular region, the brows deflate and the space between the brows and upper eyelids hollows. Deflation of the brows can cause and/or be associated with drooping of the brows. It is important for your Oculoplastic Surgeon to recognise this and discuss addressing this when planning periocular rejuvenation.

Skin Changes:

Skin loses its elasticity with age. Eyelid skin stretches, sags and can become wrinkled. Options for addressing these changes include surface treatments, such as laser and peels, and/or more interventional treatments such as blepharoplasty surgery.

Irritable, tired eyes…

Irritable, tired eyes are often a consequence of drying, i.e. having an inadequate ‘tear film’. There are two important factors when considering your ‘tear film’:

1. The volume of tears produced

2. The stability of the tear film

Your Ophthalmologist will be able to determine which or, quite often, if both of these factors need addressing to cure your symptoms.

A low volume of tears can be treated with artificial tear supplementation or occlusion of tear drainage. An unstable tear film is often caused by eyelid margin inflammation (blepharitis) which can be treated with eyelid margin cleaning, omega 3 supplements e.g. flax seed oil, and occasionally oral antibiotics e.g. doxycycline.

I have a lump on my eyelid, what should I do?

The majority of eyelid lumps are irritating but not serious.

Your Oculoplastic Surgeon will often be able to make a diagnosis by listening to you and through examination alone. Sometimes further tests such as biopsy (taking a sample) may be required.

Treatments vary from hot compresses, simple incision to margin controlled excision plus reconstruction. Margin controlled excision is used to ensure complete removal of eyelid tumours to minimise recurrence. Following excision of a tumour eyelid reconstruction may be required. It is extremely important that your surgeon is well versed in the anatomy and function of eyelids to provide you with the best outcome possible.