Sometimes after a patient has cataract surgery, a patient’s eyelid can become droopy. This is most often due to the instrument called the eyelid speculum that keeps the eyelid open during surgery. This instrument is necessary so the surgeon can work on the eye and remove the cataract. As can be imagined, if a patient was constantly blinking during surgery, it would difficult if not impossible for the surgeon to perform the surgery properly.

The eyelid speculum, can stretch the eyelid muscle called the levator and create ptosis. This muscle when stretched or detached from where it normally sits, will cause the eyelid to be droopy. This drooping or ptosis, is something that fortunately can be fixed. As an eyelid specialist or oculoplastic surgeon, I commonly fix drooping eyelids. There are couple things to remember though if you have a drooping eyelid after cataract surgery.

First, the drooping eyelid most often gets better on its own. Sometimes, the irritation to the eye from surgery itself can cause the eyelid to stretch and the eyelid to become droopy. This resolves in a couple weeks and the eyelid can come back to a normal position within a month.

Second, if in a month the eyelid is still drooping, then the muscle may be stretched. The good news is that this also often self corrects. The time period for this is usually six months or so. In patients who have had cataract surgery and have a drooping eyelid, I wait about 6 months before performing surgery.

Third, if the eyelid is still drooping after cataract surgery six months later, it is possible to tighten the muscle to raise it. This is an outpatient procedure that takes about 30 minutes. Often if the other eye is going to have cataract surgery, I would wait until after that eye is done so if it also becomes droopy, both eyelids can be done at the same time. In the surgery, the levator muscle is tightened back to its original spot. The surgery has a 90% success rate and the recovery is about a week.

The big question is what to do if a patient has a drooping eyelid and a cataract. In the photo above, the patient has a cataract in the right eye and a drooping eyelid. Which do you do first? Do you lift the eyelid and then cataract surgery or vice versa? The answer is that you first do the cataract surgery. This way, if the eyelid drops more after surgery, it can be lifted. Usually we don’t raise the eyelid first because the cataract surgery may make the eyelid redrop again. As an eyelid specialist in Denver who deals with drooping eyelids after cataract and other reasons, this is one of the most common things I see. I hope this helps!