Examination Of The Upper Eyelid And Eyelid Skin-Fat Examination

    The upper eyelid is evaluated for excessive skin, herniated orbital fat, abnormal eyelid creases, ptosis, retraction, and prolapse of the lacrimal gland.

    The amount of excessive skin and whether the skin is more redundant over part of the upper eyelid are determined. The surgeon finds herniated orbital fat by noting fullness in the upper eyelid, especially nasally and, at times, centrally. Lifting the lid fold by elevating the brow and simultaneously pushing on the eye through the lower eyelid can increase the fat herniation in the suspected areas and verify that the fullness is due to fat, not edema.
Fat generally flows forward during this maneuver, whereas edema of the eyelids remains unchanged. Preoperative determination of excessive skin and herniated orbital fat establishes candidates who would benefit by the excision of these tissues.