What are the treatment options for hooded eyelids?

Treatment Options for Hooded Eyelids

For hooded eyelids, surgical blepharoplasty is the most effective definitive treatment, while non-surgical options like eyelid hygiene can help manage associated symptoms but will not correct the underlying anatomical issue. 1

Non-Surgical Management Options

• Apply warm compresses to the eyelids for 5-10 minutes once or twice daily to improve circulation and reduce inflammation in the eyelid area 2
• Perform gentle eyelid cleansing and massage after warm compresses using either diluted baby shampoo or commercially available eyelid cleaners on a cotton ball, swab, or clean fingertip 2
• Use eye cleaners containing hypochlorous acid (0.01%) which have strong antimicrobial effects and can reduce inflammation 2, 3
• Apply artificial tears to manage any associated dry eye symptoms that may occur with hooded eyelids 2
• Consider topical perfluorohexyloctane (FDA approved in 2023) which prevents tear evaporation and improves symptoms in patients with associated dry eye 2

Surgical Treatment Options

• Extended upper blepharoplasty using a scalpel-shaped excision is effective for lateral hooding of the upper eyelid, particularly when the maximum excess skin is located laterally 1
• For patients with normal brow position or minimal eyebrow ptosis whose main concern is excess upper eyelid skin and lateral hooding, a scalpel-shaped excision that is widest laterally and tapers medially is more effective than traditional crescent-shaped blepharoplasty 1
• Surgical techniques should be tailored based on the severity of the hooding:
  • For minimal hooding: Müller's muscle conjunctival resection may be sufficient 4
  • For moderate hooding with good levator function (5-10mm): Shortening of the levator palpebrae or levator muscle advancement 4
  • For severe hooding with poor levator function (<5mm): Brow/frontalis suspension may be indicated 4

Important Considerations and Precautions

• Patients with advanced glaucoma should be advised not to apply excessive pressure on the eyelids during any massage as it may increase intraocular pressure 2
• Patients with neurotrophic corneas need proper counseling to avoid injury to corneal epithelium during eyelid cleansing 2
• Surgical complications of blepharoplasty may include:
  • Infection and bleeding (rare) 4
  • Over- or under-correction of the hooding 5, 4
  • Temporary difficulties in completely closing the eye post-surgery 4
  • Widening of palpebral fissures which may create ocular irritation in allergic or borderline dry-eyed patients 5
  • Lower eyelid bowing even with minimal skin resection 5

When to Consider Surgery vs. Conservative Management

• Consider surgery when:
  • Hooding causes visual field impairment 1
  • Conservative measures fail to provide adequate symptom relief 1, 4
  • The patient desires permanent cosmetic improvement 1
• Conservative management is preferred when:
  • The patient is not a surgical candidate due to medical comorbidities 4
  • The hooding is mild and primarily causes discomfort rather than visual impairment 2, 3
  • The patient prefers to avoid surgery 4

Follow-Up Recommendations

• For non-surgical management: Follow-up based on symptom severity and response to treatment 2
• For surgical patients: Remove sutures on the fifth postoperative day and monitor for wound healing 1
• Multiple surgeries may be required in some cases to achieve optimal results 4