Consultant ophthalmologist Maria Agius, from the Saint James Eye Clinic, talks to Adriana Bishop about a scarless, pain-free solution to droopy eyelids and under-eye bags.

I am not a morning person. I put on my best wide-awake face as consultant ophthalmologist Maria Agius appears on my screen to talk about droopy eyelids and under-eye bags.

While I know my puffy eyes will ease, there are others who might always look “sleepy”, which is what Agius is here to address.

Ptosis is the medical term for droopy upper eyelids which can be caused when the nerves that control eyelid muscles are damaged perhaps following an injury, trauma or simply through the stretching of the muscle over time. 

The condition is most prevalent in older people because, with age, the skin and muscles around our eyes get weaker. In younger patients, the regular daily stretching of the eyelids as contact lenses are inserted can cause ptosis.

“In ptosis we are looking at the patient’s actual lid position,” explains Agius. “We check the central reflex from the pupil and the level that the upper eyelid sits from that pupil reflex which gives us the margin reflex distance, in other words the lid height. Normal lid height is between 3.5mm and 5mm but a lid height of only 2mm would be classified as ptosis,” she says adding that the condition becomes more accentuated when looking at a photograph of yourself, where one eye might look more ‘sleepy’ than the other.

Fixing ptosis is mercifully a quick, pain-free, minimally invasive procedure carried out under local anaesthetic and leaves no scarring. “The operation takes between 20 and 30 minutes on each eye. Afterwards the eye is covered with a pressure pad to subdue excessive swelling. If both eyes are operated on simultaneously, both are padded. The patient remains in the clinic for an hour following the procedure. The better eye is then uncovered, and the patient returns home with the other eye covered by a patch which is removed the following day.” 

It can take up to 14 days for post-op bruising and swelling to ease. Contact lenses should not be worn for at least six months.

As an ophthalmologist specialising in oculoplastic surgery, Agius also performs blepharoplasty. This procedure corrects eyelid defects such as hooded upper eyelids or by removing fat bulges (bags) under the eyes. Apart from improving the field of vision, the procedure can also aesthetically modify the eye region, in some cases turning back the clock by ten years.

“I first establish what is bothering a patient most. Not everybody wants full correction. Some people have always had hooded eyelids and don’t want to change their appearance. They might just want subtle rejuvenation. By having that extra gram of weight that sits on their eyelids removed, patients immediately notice an improvement.”

“As an ophthalmologist, eye safety is my main priority,” emphasises Agius. “I need to leave a safe amount of skin for them to blink and close their eyes properly comfortably. The recovery process is very important and can take up to six months in certain procedures, but eyelid skin heals very well.”Agius has a few golden rules about eye care.

“Avoid rubbing your eyes as it stretches eyelid skin. Sunglasses should be worn all year round and don’t forget to apply sunblock on your eyelid skin. Invest in a wide-brimmed hat. Harm from UV light is one of the factors that accelerate skin ageing. When you get to the stage that you require surgery, no amount of creams or serums is going to help, unless you start using them in your 20s.” 

For more information call Saint James Eye Clinic on 2247 2630 /1, e-mail info@stjheyeclinic.com or visit stjheyeclinic.com.