Ask Dr. Etingin: Saggy upper eyelids; Getting enough calcium

My eyelids have been a bit droopy for years, but lately it’s getting worse and affecting my vision. What can I do?

As we age, gravity takes its toll on many parts of our body, and for some people that includes the eyelids. It’s often thought that droopy eyelids—or ptosis as it is technically called—is a purely cosmetic concern. But the condition isn’t only about appearance: It can also affect your vision. Eyelids become heavy or droopy when the levator muscle, which lifts the eyelid, stretches and weakens over time. As the levator muscle weakens, it becomes harder to keep the eyes fully open. Age is not the only culprit with ptosis. Medical conditions such as an eye injury or nerve damage can leave the upper eyelid sagging lower than normal, as well.

Vision is compromised if a droopy eyelid covers part of the pupil. You may lose some peripheral vision, or you may notice that you have to tilt your head up to see better. There are surgical and nonsurgical solutions. Ptosis surgery, or blepharoplasty, is an outpatient procedure that is performed in an ophthalmologist or plastic surgeon’s office. The surgeon makes adjustments to the levator muscle to help the eyelid lift properly. The result is a rejuvenated appearance and improved vision. Initial healing may include swelling, bruising, irritation, dry eyes, and discomfort that can be controlled with medication, cold compresses, and ointment. Most people get back to everyday activities within about 10 to 14 days. You can expect the effects of upper eyelid surgery to last from five to seven years, and one revision can be performed. When droopy eyelids affect your vision, treatment is considered medically necessary, and insurance typically covers the cost of surgery.

There are also nonsurgical procedures that can help. Precisely placed Botox injections and hyaluronic acid (HA) filler injections can help tighten sagging skin above the eyes. Botox injections last approximately six months; HA injections last from 12 to 18 months. A consultation with an ophthalmic or plastic surgeon can help you decide which procedure is best for you.

How can I be sure I’m getting enough calcium?

It is essential to consume an adequate amount of calcium, to keep your bones strong and reduce your risk of osteoporosis and fractures. For postmenopausal women, doctors recommend up to 1,300 mg of calcium per day, which is equal to three to four servings of dairy. Other good sources of calcium include firm tofu, almonds, and dark green leafy vegetables. To make sure you are getting enough calcium, check the labels when you are food shopping. Foods that have at least 20 percent daily value (DV) of calcium are excellent choices. For example, a cup of fat-free milk has 300 mg or 23 percent DV of calcium, and a cup of orange juice with added calcium has 350 mg or 27 percent DV of calcium. A cup of cooked collard greens has 268 mg or 21 percent DV of calcium, and a cup of cooked mustard spinach has 315 mg or 24 percent DV of calcium.

As you get older, your body’s ability to absorb calcium declines, and postmenopausal women absorb less calcium due to decreased estrogen levels. Significant calcium malabsorption can be detected by a blood test that measures calcium levels; subtle calcium malabsorption can be detected by a blood test that measures parathyroid hormone levels. Your body requires vitamin D to maximize calcium absorption. Without adequate vitamin D, the body absorbs no more than 10 to 15 percent of calcium. If you are not getting enough calcium from food and beverages or enough vitamin D from food and sunlight, your physician may recommend a supplement.

After factoring in absorption, if you’re not sure how much calcium you’re really getting, consider seeing a registered dietitian or nutritionist to create a dietary plan that will meet your calcium and vitamin D needs.

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