What's wrong with my eye? (photos)

One of them is fine but the other goes further back and has multiple layers too it. How do I treat this? Preferably non surgical. I'm 19.

Doctor Answers 4

Droopy eye lid

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It's always difficult to make a diagnosis based on photos but from what you've submitted, it appears that you might have a ptosis (droopy eyelid) on the left side.  Of course, all the appropriate measurements need to be done to confirm that.  The crease on the left looks different from the right, which is very typical for ptosis.  For optimal result, the height of the eyelid as well as the position of the crease would have to be addressed.  From you picture it doesn't look you'd benefit from a non-surgical approach.  See an experienced oculofacial plastic surgeon for a consultation to address your condition.  During testing in the office, the doctor would explain that there is an approach for surgery where an incision is made in the eyelid crease as well as an approach from under the eyelid where the incision is hidden and which procedure would give you the best result.   Good luck!

New York Oculoplastic Surgeon
4.7 out of 5 stars 68 reviews

You appear to have eyelid ptosis; surgery is the only option to correct it

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Thank you for your question. You’ve submitted a single photo, you’re 19-years-old and concerned about the appearance of your left eye. You describe multiple folds, the overall  appearance, and want to know if there is a non-surgical solution.

In the absence of a full exam, I can still give you some guidance with my impressions based on this single photo. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. My initial impression by looking at this photo is you have a condition called ptosis. Ptosis specifically relates to the eyelid and is often referred to as eyelid ptosis. In the greater likelihood you’ve always had this appearance, it would most likely be congenital ptosis. If it is newly acquired or acquired ptosis, I advise you to very quickly seek a physician for examination because it is unusual for somebody your age to suddenly have ptosis. Assuming it is something you’ve always had, and may have gotten a bit worse, I’ll explain to you what congenital ptosis is, and what the solutions are.

Ptosis means droop, and eyelid drooping is due to a maldevelopment or lack of proper development of the levator muscle which lifts the eyelid. When this muscle doesn’t develop properly, it doesn’t work as well as a normal muscle. A normal muscle contracts and relaxes, so this muscle will neither contract strongly, nor will it relax fully. When I do a ptosis evaluation, it is a fairly involved examination: taking measurements of the height of the eyelid, the amount of movement of the eyelid, other ophthalmologic indications of the degree of eye function,  the degree of the action, and getting a basic understanding on how significant the ptosis is relative to how much it blocks your vision.

You ask if there is a non-surgical solution, and I would say simply there isn’t. In the distant past, people used to try wearing glasses that have something called eyelid crutch to push up the eyelid with the glasses, which tend not to work very well. That’s the only non-surgical solution even worth mentioning. There are situations where sometimes an eyedrop for the purpose of pictures can cause contraction of another muscle called Mueller's muscle so the eyelid elevates slightly. That might be good for taking photos, but for a more definitive solution, you need a certain kind of surgery.

Surgery for a muscle which has reasonable function is typically a procedure called levator resection, which is the muscle being shortened so the eyelid is elevated. The alternative if the eyelid muscle doesn’t work very well at all and still very droopy is a procedure called frontalis sling. Typically people understand this because when the eyelid is drooping, they tend to raise their eyebrows to try to keep their eye open. Frontalis sling surgery and that muscle that raises the eyebrows is called the frontalis muscle. What we do surgically is attach the frontalis muscle to the eyelid using a variety of different materials, everything from your own fascia which is from your leg, to banked fascia, as well as alternatives such as silicone and GoreTex™.

These are all determined based on evaluation during consultation. I suggest you meet with an oculoplastic surgeon and learn about your options. I also encourage you to actually see an ophthalmologist to get a proper eye exam and determine if there are any other visual issues that can also be managed. Sometimes people with congenital ptosis, if it blocks their vision for an extended period of time when they are very young between 0 and 6, can have a condition called amblyopia where vision doesn’t fully develop. It is important that at least a proper eye exam will be done before you undergo any eyelid surgery. You can have a more comprehensive understanding of eye health as well as the options for correction of the eyelid drooping.

I am sorry there isn’t a non-surgical option, but I think it’s important you understand the condition, and pursue the information you need to make an informed decision. Again, meet with an ophthalmologist/eye doctor/MD who can evaluate your vision and eye health, then an oculoplastic surgeon who’s an ophthalmologist who specializes in additional training in plastic surgery of the eyes and face.  I hope that was helpful, I wish you the best of luck, and thank you for your question.

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

You have Ptosis of one eyelid

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This is a common condition that is treatable with a surgical ptosis repair. Dysport or Botox injections are a non-surgical alternative but require maintenance. 

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Eyelid ptosis

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It looks like you have ptosis and may need surgical repair. Good luck with your decision to move forward and seek help.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

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