An insight into how our eyelids age and the conditions that can affect our vision with Mr Nikolas Koutroumanos

By our 60th birthday, our upper eyelids have blinked more than 160 million times.

Our eyes are not immune to the passing of time — nor, often, are the tissues surrounding them. This is unfortunate, given the value of our eyes, in both functional and psychosocial terms.

We sat down with Mr Nikolas Koutroumanos leading Consultant Ophthalmic and Oculoplastic Surgeon from the London Eye Unit, to learn about how our eyelids age over time. To reveal all from what happens during the ageing process, the common conditions associated with ageing and the signs and symptoms to be aware of.

The purpose of our eyelids…

The eyelid’s intimate and dependent relationship with the eye makes it a vital and very special part of our body’s anatomy. The upper eyelid is the more complex and well-developed structure of the two lids, functioning as the main shutter of the eye, but also as a tiny and precise windscreen wiper. Its blink, a carefully executed role, lasts less than a tenth of a second and acts to wash and lubricate the eye’s surface, or occasionally to protect it.

When not blinking, the eyelids must provide a wide enough aperture to allow the full visual field that our eyes are capable of seeing. They also aesthetically frame our eyes and as such play a vital role in our perception of their beauty.

What happens during the ageing process?

As our eyelids age, the skin gets progressively thinner and less elastic. The tissues behind the eye lose volume, tone or both leading to eyelids experiencing stretching and sagging, dropping, hollowness or malposition.

Though these changes mostly form part of our natural aging process, they are often accelerated by long-term exposure to sunlight, smoking, alcohol and certain nutritional choices that we make.

What conditions are associated with this and what is the severity of these conditions?

Stretched and heavy skin may contribute to a “hooding” effect over the upper lid, or sometimes even the lashes.

More severe cases of this condition (called dermatochalasis and estimated to affect more than one in six adults over the age of 45), are likely to obscure the upper part of the field of vision. Even in less advanced cases, patients will often describe unpleasant heaviness and a tired forehead – sometimes even a headache – by the end of the day, originating from the constant compensatory attempt at keeping the eyelids high.

Changes affecting the upper lid, such as the age-related descent of the brow or the less-common “droop” of the entire eyelid – known a ptosis, which is a separate condition.

What are the most effective treatment options?

For heavy, tired and droopy eyelids a carefully executed blepharoplasty is a straightforward, minimally invasive day-case procedure that can be extremely effective by restoring a symmetrical, fresher and youthful appearance.

Conditions affecting the upper lid such as the age-related descent of the brow or the less-common “droop” of the entire eyelid (known as ptosis) must also be carefully evaluated, so an appropriate surgical plan can be devised.

Are watery eyes a cause for concern as we age?

Changes in the lower eyelid, most often a victim of loss of strength and tightness, can lead to irritation and itchy, watery eyes in milder cases. This can lead to more severe, vision-threatening problems when such symptoms are not appropriately addressed.

How can this be treated?

In watery eye cases, for a large proportion of individuals over the age of 60, it is due to such lower eyelid changes. These changes can almost always be addressed by day-case minor surgery under local anaesthetic.

When eyelid aging is not the cause, tear spillage is often due to a true tear-duct blockage, another feature of tissue wear-and-tear, which may also be addressed by scar-less tear-duct bypass surgery (endonasal DCR), again in a day-case setting.

What are some of the procedures you regularly see and treat to help halt the aging process?

Further to these functional consequences of the aging lower eyelid, the loose skin and forward-moving fat pockets will often result in wrinkles, hollows and bags under the eyes, giving an older and tired-looking appearance, sometimes detracting from the attractiveness of the eyes.

Treatment for these conditions varies from non-surgical options such as hyaluronic acid fillers, to surgical techniques designed to address the underlying problem.

Whether it is removing bags, tightening excess skin or eliminating dark hollows, well-developed surgical techniques can be carefully combined to achieve the intended result.

What are the benefits of a patient coming to the London Eye Unit?

All patients at the London Eye Unit are seen by a specialist Ophthalmic Consultant to ensure the very best care and attention. The unit is formed of expert Consultants with a full support team including an Orthoptist, Optometrist and medical imaging, allowing for a complete ophthalmic review with most investigations completed on the same day.

Located at The Hospital of St John & St Elizabeth, the London Eye Unit offers modern treatment techniques and cutting-edge diagnostics for all eye conditions and complaints.

Make an appointment

We have a team of seven world-leading Ophthalmic Consultants including Mr Nikolas Koutroumanos that make up the London Eye Unit. To book your personalised appointment you can call us on 020 7078 3848 or email [email protected]

Flexible appointment times are available.