Distinguishing cause of droopy eyelids determines management approach
WAIKOLOA, Hawaii — There are a number of different causes of droopy or heavy eyelids, and management for each may be different, a speaker said here.
When a patient presents with a dermatochalasis-type picture, it is important to determine the cause, Wendy W. Lee, MD, said at Hawaiian Eye 2013.
Wendy W. Lee
“One of the most important steps in evaluating a patient for a [blepharoplasty] is to differentiate,” she said.
Potential causes of eyelid “fullness” include true dermatochalasis, herniation of orbital fat, blepharoptosis, pseudoptosis, brow ptosis or system conditions. For a brow ptosis in particular, blepharoplasty would not be the procedure to use, she said.
“Take a thorough history,” Lee said. Systemic conditions that might cause fullness of upper lids include thyroid eye disease, metabolic disorders, cardiac or hematologic abnormalities, allergy or lacrimal gland disease.
“I’ve seen some patients come in with droopy eyelids or fullness of the lid, and they actually have lymphoma of the lacrimal gland,” she said.
Lee said that often her patients have a combination of causes of heavy lids — for example, brow ptosis and dermatochalasis.
“In those situations, it’s important to see which component is most significant and tackle that first,” she said.
When evaluating such a case in the clinic, Lee said she uses tape to show the patient how each component would be managed to set expectations for the patient.
Disclosure: Lee has no relevant financial disclosures.