Droopy or puffy lids can result from the following three underlying problems: 1) Excessive lid skin, often an inherited tendency that worsens with age due to periodic swelling and the effects of gravity (dermatochalasis).
The loose skin can drape over the upper lashes and cause reduction of the upper field of vision.
The outer aspect of the lids is particularly prone to drooping—called temporal hooding—and imparts a "hound dog" appearance.
Dermatochalasis is frequently associated with puffiness because the orbital fat that normally surrounds the eyeball can bulge forward in to the pocket of loose skin (orbital fat prolapse). "Weighting down" of the lids can lead to fatigue, especially while reading. Some people will subconsciously use their forehead muscles to help keep their eye open.
The lower lids can also exhibit orbital fat prolapse.
2) Ptosis (TOE-sis) is failure of the upper lids to open completely. Weakness of the tendon that holds the lid up is the most common cause of ptosis, although eyelid trauma or eye surgeryare other causes.
3) Brow ptosis is due to weakness of the forehead musculature or laxity of the tissues supporting the brow. Some people with "droopy lids" actually have droopy eyebrows.
Many patients with eyelid problems have a combination of the above conditions. Surgical correction is appropriate for reduction of the visual field or for relief of discomfort and fatigue due to over-hanging skin.
Surgery is individualized to address the specific lid problem. Usually, both lids are repaired in a one hour procedure. Lid surgery is an outpatient procedure performed with local anesthesia. Patients experience little to no pain and can resume normal activity immediately. A moderate amount of swelling is to be expected, although this resolves quickly.
Many people incorrectly think of eyelid surgery as "cosmetic". While some patients undergo surgery to restore their normal appearance, in many cases visual function is the reason for surgery. Most insurance companies cover lid surgery provided certain criteria are met.