Even though you're only in your 20s or 30s, your eyelids somehow seem to have drooped—isn't your history of contact lens use long?
"Even though I just wear contacts every day, for some reason my eyes feel heavy by evening" "I feel my eyes look smaller than before, and the width of my double eyelid has gotten wider"... Do you harbor such a vague anxiety? You may be telling yourself "maybe it's just eye strain" or "I'm still young, so it can't be aging," but that symptom may, in fact, be caused by years of contact lens use. In this article, we explain the following in detail.
- The scientific reason and pathological evidence for contacts dropping the eyelid
- The clear difference in risk between hard contacts and soft contacts
- The close relationship between the years of contact lens wear shown by data andptosis
- The background of contact-induced ptosis surging in the young generation of those in their 20s and 30s
- Daily preventive measures to prevent eyelid sagging, and medical treatment options
You may think "I can't believe the eyelid droops just from using contacts for years." However, through research by ophthalmologists and plastic surgeons around the world, that causal relationship has been clearly proven. Contact lenses correct vision and provide a comfortable life, but behind that, an invisible burden accumulates on your eyelids almost every day. If you read this article, you should clearly understand what is happening deep inside the eyelid and how to protect your eyes from now on.
Do contacts really drop the eyelid?—pathohistological grounds
Do you know the "real reason" contact lenses drop the eyelid? In fact, it is not mere muscle fatigue or decline, but the "physical destruction" and "fibrosis" of tissue quietly progressing deep inside the eyelid. When it comes to ptosis, one generally tends to imagine that caused by aging (involutional ptosis), but as a major factor causing acquired aponeurotic ptosis in the young and middle-aged, long-term contact lens wear is widely recognized.
Ptosis from contact lenses is not mere superficial sagging. Through pathohistological studies that observed the eyelid tissue of actual patients under a microscope, clear structural changes have been proven. In involutional ptosis caused by aging, fatty degeneration (tissue being replaced by fat) is seen in the aponeurosis and Müller's muscle that lift the eyelid, which is characteristic. However, when the tissue of patients who had worn hard contact lenses for a long time was examined, fatty degeneration was hardly seen; instead, clear fibrosis and abundant proliferation of collagen fibers were confirmed in Müller's muscle (Watanabe et al. 2006).
Fibrosis is a phenomenon in which tissue is damaged and hardens and degenerates. This severe fibrosis of Müller's muscle is the biggest characteristic of contact-lens-induced ptosis and is thought to be the fundamental cause of the eyelid no longer functioning normally. Furthermore, it has also been confirmed that the "levator aponeurosis," the lead in lifting the eyelid, and the "Müller's muscle" behind it are thinly stretched (attenuation and elongation) by years of physical stress and ultimately come off (disinsertion) from the cartilage that forms the core of the eyelid (the tarsal plate). In other words, long-term contact lens wear reliably alters the internal structure of the eyelid at the microscopic level.
The damage mechanism to the levator aponeurosis—repeated stimulation piling up
So, why does the internal tissue of the eyelid get destroyed just from using contact lenses? The main causes are the "physical traction force" repeated when putting on and taking off the lens daily, and the "friction" accompanying lens wear.
When you take off your contact lenses every day, aren't you unconsciously pulling the skin of the eyelid strongly with your fingers? This casual action keeps applying excessive traction force to the levator aponeurosis and Müller's muscle. When one study investigated patients with contact-lens-related ptosis, it was reported—astonishingly—that 100% of patients pulled the upper eyelid when putting on the lens, and 72.2% of patients also pulled the upper eyelid strongly when taking off the lens (Freitag et al. 2015). This physical pulling repeated every morning and night gradually stretches the aponeurosis and ultimately peels it off from the tarsal plate.
Furthermore, the habit of rubbing the eyes due to the stimulation of the lens itself, dry eye from the dryness characteristic of contact lenses, allergic conjunctivitis, and so on also causes great damage. In particular, the act of rubbing the eyes strongly upon feeling dryness immediately after removing the lens brings direct destructive force to the levator aponeurosis and Müller's muscle inside the eyelid, accelerating the thinning and elongation of the tissue.
Why hard contacts are especially high-risk
Among contact lenses, hard contact lenses in particular are known to have an extremely high risk of ptosis. According to a meta-analysis (a high-precision statistical analysis) that integrated data from multiple past studies, it is shown that hard contact lens wearers have, compared with non-wearers, a risk of developing ptosis that soars to as much as "17.38 times" (Hwang et al. 2015).
One reason the risk of hard lenses is high is the physical friction from the hardness and thickness of the lens itself. For example, hard lenses for correcting high myopia tend to have a thick lens edge. Every time you blink, the back of the eyelid keeps getting strongly rubbed against the edge of this hard, thick lens, producing chronic stimulation and friction. This repeated mechanical friction causes inflammation and fibrosis in Müller's muscle.
In addition, the "way of removing" characteristic of hard lenses is also viewed as a problem. Not a few people perform a method of strongly pulling the outer-corner side of the eyelid sideways with a finger and using a blink to flick the lens off. Many researchers point out that this strong sideways traction is a dangerous action that directly induces disinsertion of the levator aponeurosis.
Are soft contacts safe?
"If hard lenses are dangerous, switching to soft lenses is safe"—do you think so? In fact, the latest research data thrusts the harsh reality that even soft lenses can by no means be called safe. While the risk is indeed lower than with hard lenses, the meta-analysis found that even soft lens wearers have a ptosis risk "8.12 times" (Hwang et al. 2015) that of non-wearers.
Because soft lenses are soft and conform easily to the eye, the damage from friction may be less than with hard lenses. However, even with soft lenses, the action of pulling the eyelid when putting on and taking off the lens is unavoidable, and with long-term use, damage to the eyelid will surely accumulate. In fact, in a survey conducted at a Taiwanese medical institution, it was reported that about 80% (28 of 35) of young patients diagnosed with ptosis caused by contact lenses were soft contact lens wearers (Lee et al. 2019). In another study too, 60% of contact-related ptosis patients were soft lens users. Considering that, currently, soft contact lens users are overwhelmingly the majority worldwide, the number of potential soft-lens-induced ptosis patients can be thought to be considerable.
Seen in data—the relationship between years of use and risk
The risk of developing ptosis is closely linked to the years of contact lens use. The longer you use them, the more physical damage to the internal structure of the eyelid accumulates, causing irreversible change. In a large-scale study conducted in Taiwan, it was reported that the average years of use of patients diagnosed with contact-lens-induced ptosis was about 11.26 years (Lee et al. 2019).
Furthermore, in a collaborative study in the US and elsewhere targeting a group of contact-related ptosis patients who underwent the surgery called Müller's muscle-conjunctival resection (MMCR), the patients' average history of contact lens wear reached "20.6 years" (Freitag et al. 2015). This study also revealed that the longer the period of contact lens wear, the greater the severity of the ptosis. For example, if you start using contacts at age 12, by the time you are 32 you already have a 20-year history of wear, and by calculation severe damage has accumulated inside the eyelid.
Especially in the case of hard contact lenses, in the pathological examination of a patient group whose average period of wear reached 25.4 years (Watanabe et al. 2006), irreversibly severe fibrosis was confirmed in Müller's muscle. As one ages, the collagen and elastin of the skin and supporting tissue decrease, and the elasticity of the tissue naturally declines. When this natural weakening due to aging combines with the physical damage from years of contact lens wear, the progression of ptosis accelerates all at once.
Hard vs. soft, a detailed risk comparison
There is detailed research data that directly compared patients who needed surgery due to contact lenses, between hard lens wearers and soft lens wearers. Looking at this data, the magnitude of the destructive force that hard lenses give to the eyelid becomes apparent.
There is an indicator showing the degree of eyelid lift before surgery, "MRD1 (Margin Reflex Distance 1: the distance from the center of the pupil to the edge of the upper eyelid)." A normal eye has sufficient MRD1, and the smaller the value, the more heavily the eyelid droops (the more severe it is). As a result of the study, whereas the preoperative MRD1 of soft lens wearers averaged 1.7 mm–2.0 mm (Freitag et al. 2015), that of hard lens wearers averaged a significantly lower 0.75 mm–0.8 mm, proving that hard lens wearers caused far more severe ptosis.
Why does it become so severe? As a factor, it can be cited that hard lens wearers have a significantly longer average period of wear. In the same study, it was found that whereas the average period of wear of the soft lens group was 13.0 years, that of the hard lens group was 28.1 years—they kept using them for a very long period. In other words, it is concluded that hard lenses tend to be worn over a long period, and as a result of the accompanying physical friction and traction force at insertion and removal accumulating over many years, they tend to cause more serious and severe ptosis.
To you who think "but I'm still young"—cases with a long history of contacts
Those who think "ptosis is an old person's disease, right?" need to revise their understanding. Involutional ptosis due to aging generally becomes prominent after the 40s, especially in the 60s and older, but ptosis caused by contact lenses frequently develops even in the young generation of those in their 20s and 30s.
In fact, in a study targeting patients diagnosed with contact-induced aponeurotic ptosis, it was reported that the age range was 12 to 38, with a very young average age of "28.95." This shows that as a result of starting vision correction from one's middle-school or high-school days and continuing to use contact lenses every day, the eyelid has already reached its limit by the late 20s.
In recent years, not only vision correction but also the wear of cosmetic color contact lenses and circle lenses has become a daily routine, centered on young women. As a result, the base of contact lens wearers in the young population has widened, and cases of complaining of ptosis symptoms at a young age are increasing. In fact, it has been pointed out that even with mild ptosis, among young patients who visit clinics wishing for "double-eyelid cosmetic surgery (cosmetic surgery)" due to aesthetic dissatisfaction such as the eyes looking small or the width of the double eyelid changing, cases in which ptosis from contact lenses is in fact hidden are very common. Those who feel heaviness of the eyelid or disorder of the double eyelid even though they are only in their 20s or 30s—that may be, not mere aging or fatigue, but a sign that the tissue has reached its limit due to years of contact lens history.
What you can do for prevention
Eyelid tissue that has once been stretched or has fibrosed and hardened does not return to its original state naturally. Therefore, "prevention" to keep the eyelid from drooping further becomes very important. To prevent contact-induced ptosis, we introduce several daily preventive measures you can adopt starting today.
Treatment options for contact-induced ptosis
If the eyelid has already drooped and there is hindrance to daily life—a narrow field of vision, fatigue so severe by evening that you can't open your eyes, severe headache or stiff shoulders—unfortunately, recovering on your own is difficult. However, medical surgical treatment is very effective, and many patients have regained a comfortable field of vision.
Ptosis from contact lenses is caused by a "physical connection failure" in which the muscle or tendon of the eyelid has come off or stretched, and it is characterized by the fact that the force of the muscle that lifts the eyelid (levator function) itself is often kept good. Because the muscle itself is healthy, surgery that repairs the physical connection, like sewing and shortening a stretched rubber band, works well.
Main surgical methods include the "levator advancement" that incises the surface of the eyelid (the skin side) and re-sutures the detached aponeurosis to the cartilage (the tarsal plate), and the "Müller's muscle-conjunctival resection (MMCR)" that approaches from the back of the eyelid (the conjunctival side) and shortens the stretched Müller's muscle. MMCR surgery in particular has the merit of leaving no scar on the skin and is very effective for patients with contact-related ptosis. In one study, it was reported that surgery succeeded (postoperative MRD1 recovered to 3 mm or more, or asymmetry improved to within 1 mm) in 93.5% of contact-related ptosis patients who underwent MMCR. Much data shows that through surgery, the field of vision widens, the habit of raising the chin to look at things is corrected, and eye fatigue is dramatically reduced, so the quality of life (QOL) is greatly improved in many cases.
If you find yourself thinking, "What about my case?"
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Summary of this article
Those who have used contacts for a long time and are concerned about changes in the eyelid, please feel free to consult us first.
References
- Watanabe et al. 2006. Histopathology of Blepharoptosis Induced by Prolonged Hard Contact Lens Wear. Am J Ophthalmol. 2006 DOI
- Freitag et al. 2015. Association between contact lens wear and blepharoptosis. Ophthal Plast Reconstr Surg. 2015 DOI
- Hwang et al. 2015. Risk of Blepharoptosis in Contact Lens Wearers. J Craniofac Surg. 2015 DOI
- Uchinuma et al. 1983. Blepharoptosis Induced by Hard Contact Lenses. Ann Plast Surg. 1983 DOI
The author of this article
Hiromitsu Nakamura Physician
Zetith Beauty Clinic Ginza / Osaka / Fukuoka
He has a track record of research presentations at domestic and international conferences in Japan and is also involved in technical guidance and education across the entire Zetith Beauty Clinic. Specializing in precise cosmetic medicine based on anatomical grounds, he pursues natural results tailored to each individual's bone structure and tissue.