Treatment Options for Hooded Eyelids
The definitive treatment for hooded eyelids is surgical correction through blepharoplasty, which addresses both functional and aesthetic concerns by removing excess skin and repositioning tissues. 1
Non-Surgical Management Options
Non-surgical approaches can provide temporary relief for mild cases:
- Apply warm compresses to the eyelids for 5-10 minutes once or twice daily to improve circulation and reduce inflammation 2
- Perform gentle eyelid cleansing and massage after warm compresses using diluted baby shampoo or commercially available eyelid cleaners 2
- Use eye cleaners containing hypochlorous acid (0.01%) which have strong antimicrobial effects and can reduce inflammation 2
- Apply artificial tears to manage associated dry eye symptoms that may occur with hooded eyelids 2
Surgical Management
For moderate to severe hooded eyelids affecting appearance or vision, surgical intervention is recommended:
- Upper blepharoplasty - The primary surgical treatment for hooded eyelids, involving removal of excess skin, muscle, and sometimes fat 3, 4
- Extended upper blepharoplasty - A scalpel-shaped excision technique that is particularly effective for lateral hooding, removing maximal skin where most needed 3
- Combined procedures - When hooded eyelids are accompanied by ptosis (drooping eyelid), combined blepharoplasty with ptosis correction may be necessary 1
Specific Surgical Techniques
- For minimal ptosis: Müller's muscle conjunctival resection or Fasanella-Servat procedure 5
- For moderate ptosis with levator function of 5-10 mm: Shortening of the levator palpebrae or levator muscle advancement 5
- For severe ptosis with levator function <5 mm: Brow/frontalis suspension 5
Important Considerations
- Patients with advanced glaucoma should avoid applying excessive pressure on the eyelids during massage to prevent increased intraocular pressure 2
- Patients with neurotrophic corneas require proper counseling to avoid injury to the corneal epithelium during eyelid cleansing 2
- Conservative management is preferred for patients with mild hooding who are not surgical candidates due to medical comorbidities 2
- Surgical revision rates are higher (9.2%) when blepharoplasty is combined with ptosis correction compared to blepharoplasty alone (3.8%) 1
Potential Complications of Surgery
- Infection, bleeding, over- or undercorrection, and reduced vision (rare) 5
- Temporary difficulties in completely closing the eye immediately after surgery 5
- New dry eye symptoms (0.8% of cases), which typically resolve within 3 months 1
- Asymmetry between eyelids may occur, sometimes requiring revision 5, 1
Follow-Up Recommendations
- For non-surgical management: Follow-up based on symptom severity and response to treatment 2
- For surgical management: Follow-up typically includes assessment at 5 days post-operation for suture removal, with additional visits as needed 3
- Some patients may require more than one operation to achieve optimal results 5