Unilateral Eyelid Repair Making Other Eyelid Droop, What Can Be Done? (photo)

I had a unilateral eyelid repair (from the inside of the lid) 10 days ago, and now my other eye is drooping, similar to how the operative eye looked prior to the surgery. The operative eye looks very "big and awake" and now the other eye looks very "small and droopy". I had the now small and droopy eyelid unilaterally repaired 8 months ago as well and now it now looks worse than before either surgery. I don't understand why the nonoperative eye looks worse & both eyes are so uneven.

Doctor Answers 6

Unilateral Eyelid Repair Making Other Eyelid Droop, What Can Be Done

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It is very common for the recently operated on eye to look overcorrected for a few weeks. When that happens the light that reaches the retina on the larger eye will send messages to the brain that the eye is too open, and at times, the brain will react by sending a message to the eyes to relax and that might cause the left side to drop. It should all balance out in a couple of weeks as things soften and settle down.

Complex brain-eyelid nerve relationship

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As mentioned by another surgeon here, what you are describing is called Hering's Phenomenon. When two eyelids are asymmetrically droopy, and the more droopy eyelid is fixed surgically, the brains input to raise the eyelids diminishes, and the less droopy eyelid now becomes more droopy.

This can happen to as many as 15% of patients with droopy eyelid. It is an important phenomenon to check for prior to surgery so that the patient can be counseled to the possibility of this phenomenon postoperatively.


A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

Non operated eyelid dropped

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This is called the Hering's phenomenon. It is a matter of balance. You actually had ptosis in both eyes, the left side was latent and only showed up when the one side is fixed. Often we can tell preoperatively this is going to happen but not always. The difficulty is in getting the insurance to pay for the eyelid that looks normal. Have the left one worked on.

Very common situation.

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It is essential to assess for latent ptosis.  Failing to note this in the pre-operative consultation is a major cause for post-operative disappointment.  There is a saying in surgery that talking about something before surgery is an explanation but talking about it after surgery is an excuse.  I recommend discussing your concerns with your surgeon and see where that takes you.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

You had ptosis that was not treated

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The drop of the non-treated eye is due to the ptosis. The best would have been to repair the ptosis in both eyes at the same time.


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This is a common problem with ptosis repair. You actually had ptosis in BOTH your eyes before surgery. Your facial muscles compensate for the ptosis by trying to open your eyes. When the worse eye is fixed, your body loses the drive for compensation and the other eye then looks droopy. Simply return to your surgeon to have the other eye repaired as well. Remember, perfect symmetry is often impossible to attain, but a second surgery should help.

J. Charles Finn, MD
Raleigh-Durham Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.