Salman Rushdie's brooding, heavy lidded look always seemed more an expression of boredom than a medical condition. He had the face of a man who had endured the stupidity of others with dignified patience for years. But after a couple of hours on the operating table he now looks positively avuncular.
For years Rushdie has been suffering from a condition known as ptosis, which is caused by a weakness in the tendon of the muscle of the upper eyelid. It had become so bad that, without an operation, in a few years time, he wouldn't have been able to open his eyes at all.Charles Sandy, fellow in ocular plastic surgery at London's Moorfield Eye Hospital, says ptosis is fairly common. "We do 300 operations for this condition every year. It's a very successful procedure."
Although it's possible to be born with ptosis, due to an inherent muscle abnormality, most cases are simply a result of aging. The older you are, the more likely you are to suffer. "We don't know why some people get droopy lids and others don't," says Sandy. "But we all age differently and this is one more example of age-related weakness."
Just as the muscles in your face start to sag as you age, the eyelid, which also has to work against gravity, appears to be vulnerable to the passage of time. Only rarely is the condition due to nerve or muscle damage or a defect that affects nerve signals.
Most sufferers begin to notice symptoms around the age of 50, which usually get worse as time passes, until eventually they find it almost impossible to open their eyes at all. Just before Salman Rushdie underwent surgery last month, he said he sometimes had to resort to holding one eye open with his finger because the muscle had become so weak. "If I went to the cinema I'd get a headache after 15 minutes," he told London's Sunday Times.
Sandy says headaches occur "because the sufferer can only keep their eyes open by using the muscles in their forehead. You don't have to do this for too long before a headache starts."
There's absolutely nothing you can do to prevent or treat the problem yourself. No amount of eye aerobics will improve the muscle strength and early nights won't make you look any more alert. Equally, novel writing or living under the strain of a death threat for years doesn't cause the problem either.
The only option once the lids have drooped so far is surgery. The operation simply involves making the muscle shorter. "It's known as an anterior levator repair," says Sandy. "All we do is advance the levator muscle which lifts the lid and this has the effect of tightening it. It's very effective and side effects are rare."
If the muscle weakness is so bad that the lid no longer works at all, an operation that involves implanting an extra piece of tissue may be necessary.