If you’ve looked in the mirror and noticed you have uneven eyelids, you’re not alone. Facial asymmetry is very common. Unless your face is one of the few that is perfectly symmetrical, it’s not unusual for your facial features, including your eyes, to appear uneven.
Most of the time, uneven eyelids are a cosmetic concern rather than a medical problem. However, some serious medical conditions can cause your eyelids to appear uneven.
Though uneven eyelids may be caused by normal facial asymmetry, there are some medical conditions that may cause your eyelids to droop or appear uneven.
Ptosis, or droopy eyelid, is a condition that can affect one or both eyes. It can be present at birth (congenital ptosis) or develop later in life (acquired ptosis). Ptosis can range in severity and cause the upper eyelids to droop low enough that they reduce or block vision.
Ptosis can affect anyone, but it’s more common in older adults. Stretching of the levator muscle, which holds up the eyelid, is a common part of aging. Sometimes the muscle can separate completely from the eyelid. Ptosis can also be caused by trauma or be a side effect of eye surgery. Neurological conditions, stroke, and tumors can also cause ptosis.
Uneven fat distribution in the eyelids
Anyone can have uneven fat distribution in the eyelids, though it becomes more common as we age. Over the years, your eyelids stretch and the muscles that support them weaken. This can result in excess fat accumulating above and below your eyelids.
Tics are sudden, brief repetitive movements (motor tics) or sounds (vocal tics). Motor tics can cause blinking or grimacing the face. One side may be more active than the other, which may give the appearance of uneven eyelids. Tics are more common in children and adolescents. Most tics disappear on their own.
The cause of tic disorders is unknown, but they often run in families. Sometimes tics develop because of another condition or infection. Stress and fatigue appears to worsen tics.
Bell’s palsy is temporary facial paralysis that affects more than 40,000 Americans each year. It results from damage or trauma to the facial nerves that are responsible for facial expressions and movements such as opening and closing the eyes, and blinking. Bell’s palsy interrupts these signals, which leads to one-sided facial weakness or paralysis.
Symptoms of Bell’s palsy include:
- drooping of an eyelid and corner of the mouth
- excessive tearing in one eye
- excessive eye or mouth dryness
Recovery time can vary, but most people start to get better within two weeks after the onset of symptoms and recover completely within three to six months.
Apraxia of lid opening
Apraxia of lid opening is the inability to open your eyes after they’ve been closed. It can affect one or both eyes and is sometimes related to an underlying neurological condition, such as Parkinson’s disease.
Some people experience sleep-induced apraxia and have trouble opening their eyes after sleeping. There is no known cause.
A stroke is a medical emergency that requires immediate treatment. It occurs when the blood supply to part of the brain is reduced or blocked and starves brain tissue of oxygen and nutrients. Brain cells begin to die within minutes, which is why prompt treatment is crucial.
Delaying treatment greatly increases the risk of permanent brain damage and even death.
Other signs and symptoms of a stroke include:
- trouble speaking
- loss of balance
- numbness or paralysis of the face, arm, or leg
- sudden vision problems in one or both eyes
- sudden, severe headache
Call 911 right away if you suspect that you or someone else is having a stroke.
Trauma or surgery complications (nerve damage)
Damage to the facial nerves following trauma or surgery can result in drooping of the eyelid, or weakness and paralysis of the muscles around the eye.
Normal facial asymmetry
Normal facial asymmetry can make it appear as if you have uneven eyelids, even though they may actually be the same shape and size. A 2014 study of people who were evaluated for cosmetic upper eyelid surgery found that most had brow or eyelid asymmetry.
The treatment for uneven eyelids depends on the severity of symptoms and the cause.
Surgery is the recommended treatment for ptosis in children and adults. Ptosis surgery is usually performed as an outpatient procedure in an ophthalmologist’s office.
Depending on the severity of your condition, the surgeon may only need to make a small adjustment to lift the muscle, or the levator muscle may need to be reinforced and reattached to your eyelid.
The symptoms and severity of the condition can vary from person to person, but most people recover fully from Bell’s palsy, often without treatment. A doctor may suggest medication or other treatment options, depending on your symptoms and the suspected cause. These may include:
- antiviral drugs
- physical therapy
Very rarely, cosmetic surgery may be used to correct facial nerve problems that don’t resolve.
Tics often disappear on their own before adulthood. Tics are only treated if they significantly interfere with a person’s activities or self-image.
Treatment may include:
- cognitive behavioral therapy
- comprehensive behavioral intervention for tics (CBIT)
- antipsychotic medication, such as haloperidol and risperidone (Risperdal)
- clonidine (Catapres, Kapvay)
Treatment for stroke depends on the type of stroke a person is having and the areas of the brain affected.
Treatment may include:
- IV clot-busting drugs, including tissue plasminogen activator (tPA)
- endovascular procedures
Uneven eyelids surgery
Cosmetic surgery to correct uneven eyelids is called blepharoplasty. During the procedure, excess skin, fat, and muscle is removed from your eyelids. The surgery can involve the upper and lower eyelids and entails making an incision along the crease of your upper lid or in the crease just below your lower lash line.
Uneven eyelids surgery is performed as an outpatient procedure. The surgeon injects a numbing agent into your eyelids. You are given medication through an IV to help you relax during the procedure.
Bruising and swelling generally improves in 10 to 14 days. Scars from the incisions can take several months to fade.
The cost of cosmetic eyelid surgery varies depending on where the procedure is performed and the experience of the surgeon. The average cost of the surgery, according to a 2017 report from the American Society of Plastic Surgeons, is $3,026, not including anesthesia, hospital facilities costs, and other related expenses.
Most health insurance plans do not cover cosmetic procedures, though surgery to remove excess skin that covers the eyelashes may be covered. Check with your health insurance provider.
The internet is full of tricks and tips for treating uneven eyelids, ranging from using tape to lift the eyelids to creating new eyelid creases using exercises that involve pulling and tugging at the skin. Not only do these methods not work, but they can also be dangerous and potentially damage your eyes.
It’s best to speak to a doctor about treatment options, especially if your uneven eyelids may be caused by a medical condition.
Having uneven eyelids is usually a cosmetic concern that doesn’t require medical treatment. Speak to a doctor if your eyelids are interfering with your vision or if you’re concerned about an underlying medical condition.
An eyelid that suddenly appears droopy or uneven or is accompanied by slurred speech or numbness could indicate a stroke and requires emergency medical care.