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Why Do I Have A Droopy Eyelid After Cataract Surgery?

Why Do I Have A Droopy Eyelid After Cataract Surgery?

Does my eyelid look a little droopy? You may not be going crazy. Your eyelid may in fact be a little droopy! And as a direct result of your cataract surgery.

Cataract surgery has long been known to increase the risk of getting a droopy eyelid (also known by the medical name ptosis). It can be temporary and transient that resolves by about 6 months following cataract surgery. But it also can be permanent and require an additional surgery to fix.

Which one do you have? Well, really only time will tell (…if your droopy eyelid doesn’t get better on its own). But let’s take a look at why it happens after cataract surgery.

Transient Droopy Eyelid

The eyelids aren’t directly involved in cataract surgery. But they are in the wrong place at the wrong time - so to speak. Both during surgery and even after surgery as well.

Our eyelids cover and protect the eye. But during cataract surgery, the eyelids must be pushed out of the way so the whole eye can be seen. This also prevents your own blinking from getting in the way of the surgery.

To push the eyelids out of the way, an eyelid holder or eyelid retractor instrument is used.

Eyelid holder used during cataract surgery

Eyelid holder used during cataract surgery

This instrument works well. And allows the cataract surgeon to successfully remove the cataract.

But the eyelids suffer a little bit as a result of this instrument. This eyelid holder can compress the eyelids and cause a little bit of local trauma to the delicate eyelid structures.

This can cause the eyelid to develop some swelling after cataract surgery which can mechanically cause the eyelid to be heavy and droopy.

This droopy eyelid, however, is only temporary. As the swelling resolves (which many do within a day or two after cataract surgery), the eyelid returns back to its normal position.

Longer After Surgery

But developing swelling of the eyelid isn’t the only way the eyelid can temporarily become droopy after cataract surgery. Another very common cause is actually inflammation on the eye.

All surgeries will cause some inflammation on the eye. (Since a surgery is in fact a controlled “injury” to the eye). And cataract surgery is no exception. Fortunately, however, this inflammation tends to be pretty minimal.

After cataract surgery, inflammation can exist not only inside the eye where the cataract was removed, but also on the surface of the eye. The surface of the eye goes through a lot during cataract surgery. It can become irritated by all the eye drops being used during and after cataract surgery and also from being exposed during the surgery part itself. This irritation causes some micro-injuries to the surface of the eye and causes extra inflammation.

This inflammation gradually heals up over time (and using the prescription eye drops and preservative free artificial tears help), but until this inflammation heals up it can be annoying.

Most commonly, this inflammation can cause the eye to feel uncomfortable or cause an eyeache. But inflammation can also cause the eyelid muscles to not work as well; leading to a droopy eyelid.

As inflammation can take some time to fully heal up (check out Precisely How Long Does It Take To Recover From Cataract Surgery), this droopy eyelid after cataract surgery can take a little longer to resolve as well.

Permanent Droopy Eyelid

While annoying in the short term, that’s all fine if the droopy eyelid eventually resolves. But what if it doesn’t?

There is a chance of developing a permanent droopy eyelid after cataract surgery. And there is one major cause.

Let’s go back to that eyelid holder. While necessary for a safe and successful cataract surgery, this eyelid holder still compresses and squeezes the eyelids causing some local trauma and some eyelid swelling. But this eyelid holder can stretch the eyelids TOO much and prevent one of the critical eyelid muscles from working.

Within our eyelid is a rigid structural component at the edge of the eyelid called the tarsus. Attached to this by a thin fibrous attachment is the main muscle that allows us to open our eyelids.

The parts of the eye that allow us to lift our eyelids

The parts of the eye that allow us to lift our eyelids; image by Henry Vandyke Carter, Public domain, via Wikimedia Commons / highlighted from original

Gradually over time, this thin fibrous attachment can get thinner and weaker and even become detached from this rigid eyelid tarsus. When this happens, the main eyelid muscle can’t effective open up the eyelids - this causes the eyelid to be droopy.

The stretching from the eyelid holder during cataract surgery can exacerbate a weak muscle attachment and cause it to become even weaker, more stretched out or even detached.

This cause of a droopy eyelid won’t resolve on its own after cataract surgery.

What now?

But that doesn’t mean that there isn’t a fix, it just requires another surgery.

Fortunately, this eyelid surgery is a very common and straightforward surgery with good success. The eyelid surgeon surgically reattaches the muscle to the rigid eyelid tarsus.

Is A Droopy Eyelid Something To Worry About?

If you do end up with a significant droopy eyelid after cataract surgery, chances are that you won’t have to live with it for the rest of your life. Maybe just for a few months.

So the risk of having a droopy eyelid after cataract surgery isn’t a reason NOT to have cataract cataract surgery. Having the cataract removed is likely to make a much more significant impact on your overall vision and quality of life.

But the risk is still there. About 2% of individuals will notice their eyelid being more droopy after cataract surgery.

And in fact, the true number may be even less than that. For decades, we’ve known that cataract surgery can increase the risk of a droopy eyelid after cataract surgery. So many of the studies evaluating the risk are more than 20 years old.

Cataract surgery has changed significantly in the past few decades. It has become quicker and more efficient as well as less invasive. Some of the techniques used in the past known to increase the risk of a droopy eyelid (such as applying anesthetic blocks to the eye or using sutures) are more rarely done today. And so while the risk is still there, there is less concern over a droopy eyelid after cataract surgery than in the past.

Summary

Cataract surgery can increase the risk of developing a droopy eyelid. In many cases, this droopy eyelid is short-term and temporary and resolves some months out after cataract surgery. But other times, cataract surgery can cause a permanent droopy eyelid that must be repaired surgically.

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