My eyelids are uneven is this just a lazy eye or is there more that needs to be corrected to my eyelid? (photo)

Thank you for your question. You describe in your question that you feel your eyelids are uneven, and you’d like to know if this is due to a lazy eye or because of something else that needs to be further corrected. You also say that you did not have this problem when you were younger, and recently your eyelids have changed appearance

I can certainly help you with this question. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon. I was first trained in ophthalmology and eye surgery, before pursuing advanced training in plastic surgery of the eyelids.

After reviewing your photos, I observed that your right eye appears to have the lower eyelid retracting downward in comparison to your left eye, which also gives it the appearance of looking more prominent. However, because what I’m looking at is only a two-dimensional representation of your three-dimensional self, there are limitations to my recommendations, and I certainly don’t want you to feel this is the only diagnosis. That said, the first question I have is whether or not the eye is simply bulging more or if this is lower eyelid retraction.

In the absence of any history of trauma or surgery, my thoughts go to a condition called thyroid-related eye disease or thyroid-related immune orbitopathy, otherwise known as Graves’ disease. This is an autoimmune condition that affects the thyroid gland as well as the tissue around the eyes, which in turn causes changes in the appearance of the eyes. Common symptoms include proptosis, where the eye becomes pushed forward; and eyelid retraction, which means that the upper eyelid can be too high and  the lower eyelid can retract downward, causing a staring appearance.

The most important thing at this point is to rule out the possibility of thyroid eye disease. You will need to see a physician or medical doctor and have them examine these changes, and then they will usually recommend an endocrinologist and an ophthalmologist to see if further workups are needed. The history of thyroid eye disease is usually where a young to middle-aged person has new onset of eye changes and can either have low thyroid, normal thyroid, or high thyroid — all of which needs to be evaluated via blood tests or imaging such as MRI.

If this is indeed thyroid eye disease at the inflammatory stage, there will be a time when it burns itself out, though this coincides with the management of hormonal levels and whether it is high, low, or normal. The fibrotic stage is the stage wherein everything has calmed down. Some people do go back to their normal appearance, while others need to have surgical procedures to restore their appearance. Such procedures include eyelid retraction repair or orbital decompression.

There are actually a number of different procedures that one can undergo to address this type of problem, but because most endocrinologists are more concerned with the medical aspects of this condition, so often are not aware of surgical procedures that can help improve the appearance of their patients. Often patients simply find us in their search for a solution for their problems.

I recommend you see a medical doctor and bring some old photos with you so you can track when these changes to your eyes started. These changes can be slow and insidious, and in other cases they can be very rapid, so there is certainly a very wide spectrum when these changes occur. In fact, some patients are surprised the changes occurred several months or years before it even drew their attention. Try to provide as much information as you can for your doctor.

In my practice, I will often observe a patient for at least a year before even considering doing surgery if I suspect that the eyelids and the eyes are in a transitional phase and are not stable. We also don’t want to automatically assume that this is thyroid eye disease; these are simply the thoughts that have occurred to me after reviewing your photos. If this turns out to be eyelid laxity or something else, then that’s good, but the important thing is that you rule out the possibility of thyroid eye disease.

I hope that was helpful and I wish you the best of luck!

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

You have a levator dehiscence ptosis of both upper eyelids but the issue is more dramatic in the left upper eyelid.  You need to find an aesthetically oriented eyelid plastic surgeon for real help.  Get more than one consultation.

Thank you for sharing your question. Your eyelids do appear asymmetric, but the photo does not show enough around the eyes to be certain of the cause of the problem. Repost a photo including the eyebrows. You might have ptosis (drooping eyelid) which can occur for numerous reasons. See an experienced oculoplastic surgeon for full evaluation and discussion of treatment options.Good luck,