One Eye Bigger than the Other
You have ptosis (droop) of your right eyelid. You need to see an ophthalmic plastic surgeon who specializes in ptosis, as your problem (unilateral) requires significant expertise to correct properly.
This is right upper eyelid ptosis.
It is probable that there is some type of compensation for the ptosis that may affect the left upper eyelid and that needs to be investigated at the time of your personal consultation. There are two approaches to ptosis and testing at the time of consultation determines which of the approaches would be best for you. Due to the history of Lasik, you are at risk of dry eye and that also needs to be considered in planning an eyelid surgery for you.
One eye bigger than the other and getting eye fatigue.
First off, you have beautifully shaped eyes, but I agree your right eye is slightly ptotic (droopy) compared to your left. Most of us have one side of our face and orbits (eye sockets) that is smaller than the other. However, this does not mean our eyelids are not usually of symmetric heights (space between the lower eyelid margin to the upper eyelid margin). It is tough to tell from your one photo, but your right pupil may be slightly smaller than your left. There is a condition called Horner's syndrome whereupon the droopy eyelid also has a smaller pupil. It can have some serious systemic associations. I'm not sure why you are getting strain with your left eye. This could be secondary to a refractive error (need glasses) or it could be getting drier since it is more open than the other eye. I'm glad your MRI was normal. If you haven't seen an ophthalmologist then I would suggest you do so to be sure nothing serious going on. If you wanted to have micro ptosis surgery to lift your right eye more open I would suggest Guy Massry (Beverly Hills), Ken Steinsapir (Beverly Hills), or Robert Goldberg (UCLA, Jules Stein). Each of these surgeons are national leaders and carry excellent reputations. Best regards.
You appear to have slight eyelid ptosis. I would direct you to be seen by an oculoplastic surgeon for evaluation and recommendations for repair.
Eyelid Asymmetry Concerns
Hello 'lumixxx', thanks for your question. It is difficult to ascertain the source of your issue without a full history and physical exam. If you truly are developing a droopy eyelid during the day, it may be worth checking for a condition called myasthenia gravis, which is an autoimmune disorder leading to neuromuscular weakness. A neurologist or ophthalmologist can help work this up. Your photo overall looks OK, other than perhaps a minimal ptosis of the right eyelid compared to your left, which sounds like it is congenital if you had it since you were a child. There is ptosis eyelid surgery that can be performed to address this, but there are risks with any surgery and you need to weigh the pros and cons of trying to fix a minimal issue with the risks of potential complications. I would suggest a neurology eval first, and if you are still interested in cosmetic eyelid options, be sure you seek a board-certified plastic surgeon for a thorough consultation. Good luck!
One eye bigger and getting tired easily
I cannot tell from your photos, however you may have ptosis of your right upper eyelid. This may be due to mild detachment of a thin muscle in your right upper eyelid called the Levator Orbitalis.
Thank you for your question. I suggest that you consult with a board certified facial plastic surgeon as a blepharoplasty can address excess skin and fatty tissue around the eyelids.
you were describing two separate issues. From the photo it seems like you have a small amount of ptosis with your right upper eyelid. This can be easily addressed. If you live in Los Angeles there are many qualified oculoplastic surgeons there. You might have a slight difference in your refractive error (prescription even though you had lasik) for this I would see a cornea specialist who would need to check your refraction and do measurements of your cornea which was lasered. You also have great options for cornea specialist in your area.Good luck
Asymmetry of the eyelids
The right eyelid is approximately 2 mm lower in the photo. You may have ptosis or pseudoptosis - but a thorough examination by an Oculoplastic surgeon would clarify what is happening. The fact that the left eye is symptomatic suggests that there might be something else contributing to the difference in the eyelids. Thyroid eyelid retraction on the left is a possibility - and this could account for the right lid being low (pseudoptosis), and for symptoms of dryness/ fatigue/ aching. An evaluation in person will provide some solid answers for you. Best wishes.