Is it normal for a 25 year old to have one droopy eyelid? (Photo)

As a cosmetic oculofacial plastic surgeon practicing for 20 years, I
have a background in eye surgery and plastic surgery of the eyes and face.
Ptosis is something I deal with a lot in my practice. People generally have a
difference of about 1-2 millimeters between the two eyes. That’s part of the
reason why your family is not acknowledging an obvious difference. However,
when you take photos or when you get tired, a lot of those differences are
obvious.



During evaluation, I would ask you to look at previous photos. There’s
a condition called congenital ptosis which is when one or both eyes are
drooping because of the development during gestation of a muscle that lifts the
eyelid called the levator muscle. Someone may have symptoms of drooping eyelid
that causes the eyelid to progress a little bit lower but they may also have
some degree of drooping eyelid throughout their lives. . In addition, any kind
of trauma that causes the eyelid to swell can make it droop because of eyelid
stretching. If that’s not the case, then we want to also rule out any unusual
neurologic issues. So an examination with an ophthalmologist,
neuro-ophthalmologist or neurologist is indicated to make sure that the eyelid
drooping is not a sign or symptom of something else that may need intervention
other than surgery.



Normally, people have drooping eyelids as they get older because the
tendon of the levator muscle called the aponeurosis tends to get thinner and
detaches. This phenomenon is called involutional ptosis and is a very common
problem as we get older. That’s an acquired ptosis, probably the most common
type of ptosis there is. However, you’re very young for that type of situation.
It is very important to establish whether or not this is congenital ptosis or
if there is any other neurologic reason for the ptosis. Once those things are
ruled out, especially the systemic issues, then you can entertain the surgical
options.



Typically, we perform ptosis surgery under local anesthesia with LITE™
sedation and it is deceptively complex procedure. It is done in a very small
space in the eyelid area where a very sensitive muscle has to be manipulated so
that the eyelid height, shape and contour are symmetric with the other eye.
There are situations with one drooping eyelid where we lift that eyelid during
an examination and the other eyelid droops. That is one of the manifestations
of Hering’s :aw which has to do with the way the brain feeds the eyelids so
that when you correct one, the other one will droop. We check that and we
decide whether or not it’s significant enough to do both eyes. We also do a
proper evaluation of eye function in terms of how you
blink and how high your eye rolls to protect the eye when you are blinking.
These are part of a standard opthamological examination.



During surgery, we often sit the patient up several times to evaluate
what the eyelid level is relative to the effects of gravity. We let the patient
open and close their eyes during surgery. They never feel any pain and they are
comfortable. This helps us predict the appearance of the eyes after the surgery
is completed. Once the surgery is completed, we basically do the same thing we
do with other cosmetic eyelid procedures. We put cold compresses in the eyes,
we observe, and a week later we take stitches out.



I suggest that you have an evaluation first by an ophthalmologist,
possibly a neurologist to eliminate the other systemic causes of ptosis. Once
that’s eliminated, then it’s time to then identify a doctor you feel
comfortable with most likely an oculofacial or oculoplastic surgeon who does a
lot of ptosis surgery. Hopefully, this surgeon has a cosmetic sense that
resonates with you. Ptosis surgery can really be very fulfilling and can
restore the patient’s confidence about the asymmetry of their eyes.



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You do have a ptosis of the right upper lid.  Your brow is also quite a bit lower, and we would expect it to actually be elevated in an attempt to get the lid higher.  It is very hard to tell from a photo but I wonder if the left eye is pushing forward a little bit as the orbits look different here.  It is also a little unusual for a young  person to have a ptosis which is worsening without some history of either  a congenital ptosis or trauma to the  eye.  You need to be seen by an oculoplastic surgeon who can evaluate the eyelid muscles, and the symmetry of the orbits.  They can then try to decide why you have the ptosis and brow ptosis.  If necessary they can do surgical repair.    

It is always difficult to make a determination from a photograph but as indicated below, you appear to have ptosis, which is a common problem, that we see every day.  Once it is determined that it is not related to any systemic or other cause with a few simple tests, surgery is usually the treatment of choice.  See an experienced board certified oculoplastic surgeon for a consultation and they can explain the surgical options and what to expect.Best of luck!