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Drooping eyelids are a common problem usually associated with aging, but can be seen in younger people, too. As an eye doctor in Hamilton, NJ, I know the effects of time and gravity are the most common cause of drooping eyelids, but it’s important to know that more sinister neurologic conditions — such as myasthenia gravis or an aneurysm — could be to blame.

In most cases involving neurological issues, drooping eyelids seem to appear overnight and may be associated with double vision and pain. In these cases, patients should be promptly evaluated and get medical or neurological treatment as soon as possible.

Far more often, the eyelids gradually sag as gravity slowly tugs on the eyelids’ skin and the muscles that lift the eyelid. An eyelid surgery specialist evaluates the structures surrounding the eyelid, particularly the eyebrow and upper eyelid skin, as part of the overall assessment. Additionally, the function of the muscles that elevate the eyelid must be determined. I pay particular attention to the status of the cornea and dry eyes, because any surgical correction of the eyelid droop may increase the dry eye symptoms.

Eyelid surgery is the only treatment for drooping eyelids. If the cause of the eyelid droop is excess skin of the upper eyelids or drooping of the eyebrows, then removing the excess skin and elevating the eyebrows can produce the desired results. If the eyelid itself is drooping, this is most often caused by the muscle that lifts the eyelid being stretched. Tightening this muscle can elevate the eyelid. Cold compresses applied after the surgery can help minimize swelling, but the eye may remain swollen and bruised for approximately 7 to 10 days following surgery.

For some, the drooping eyelids can impair vision and surgery to alleviate this condition may be covered by a patient’s health insurance policy. Part of the evaluation includes photographs and a visual field with the eyelid both at rest and elevated. Private insurance companies often evaluate the testing to determine if the surgery is covered. Medicare does not take those steps. Only an examination can determine if insurance covers the procedure.

These photos demonstrate how surgery to remove excess skin helps elevate the eyelids.

Eyelid surgery can provide an expansion of the visual field and leave the eyelids feeling more rested. If you are wondering if you might be a candidate for eyelid surgery request a consultation at Outlook Eyecare, or call us at (609) 409-2777 (Monroe Township), (609) 419-1920 (Princeton), or (609) 587-4700 (Hamilton Township).



Excess tearing can be a perpetual nuisance. The condition occurs when the amount of tears produced by the eye overwhelms the tear drainage mechanism. Even though tearing by itself never harms the eye, it can blur vision and produce discomfort in social situations. Our eye doctors in Hamilton, N.J. understand the problems caused by excessive tearing and can treat its causes.

The tear film — a complex solution made up of mucous, salt water and oil — is essential for the health of the eye. There must be a balance between the tears produced and the tears drained. That balance is achieved when tears leave the eye. This occurs in 1 of 3 ways:

  • Evaporation
  • Down the tear ducts
  • Flowing out onto the cheek

Does dry eye cause tearing?

In most cases, no. A better definition of tearing is needed to answer this question. When tears leave the confines of the eyelids and run down the cheek, that’s called tearing.  This is almost never caused by dry eyes. Dry eye patients feel their eyes are wet and may call it tearing but the tears do not run down the cheek. Instead, patients with dry eye have excess mucous and oil in the tear film and this causes a slime that makes the eyes feel wet. Incorrectly treating the condition can make tearing worse.

Nearly all excessive tearing patients have a structural abnormality of the tear drainage system. This illustration shows the tear drainage system’s anatomy. There is a small tear duct in both the upper and lower eyelids called the canaliculus. These come together and drain to the lacrimal sac. The lacrimal sac joins with the nasolacrimal duct that travels through a bony canal to exit in the nose. 

Incorrectly positioned eyelids block the small tear ducts from contacting the tear lake, preventing tears from draining. Excess conjunctiva (the clear film that covers the white of the eye) may cover the opening to the tear duct. The nasolacrimal duct may be narrow or blocked as it travels down the bony canal into the nose. Blockage of the nasolacrimal duct not only causes tearing but also an accumulation of discharge in the eye and puts one at risk for a serious infection known as dacryocystitis.

These structural abnormalities often require surgery to alleviate the blockage and restore normal tear outflow.  Fortunately, many of these procedures are relatively minor and can be performed in the office.  Some do require outpatient surgery.

Tearing can be extremely bothersome and interfere with clarity of vision and your ability to perform at your best. Fortunately, our ophthalmology practice serving Princeton, Hamilton Township, and Monroe Township have the tools and the expertise to diagnose and treat all causes of tearing. We recommend coming in for a consultation if you’re bothered by excessive tearing.



For most people, spring brings with it short sleeve shirts, outdoor activities, no more cold weather, and fun days in the sun. However, for some it means another dreaded season plagued with allergies. As an eye doctor serving Princeton, Hamilton, and other New Jersey communities, I see a lot of patients who are affected by allergies in the area.

Seasonal allergies are brought on by an immune response in certain individuals with sensitivity to certain allergens, such as pollen. As the pollens are inhaled, allergy sufferers experience rhinitis, or inflammation of their nasal passages. Symptoms include a runny nose, nasal congestion, sneezing, and itching.

If the pollens come in contact with the eyes or ocular surface, it can result in allergic conjunctivitis, otherwise know as allergic pink eye. Around 50% of allergy sufferers experience ocular symptoms. Symptoms generally include red eyes, itching, burning, and tearing. Symptoms can range from mild to very severe.

The best treatment for allergies is avoidance of the offending allergen, although this is often very difficult in regards to seasonal allergies. Some patients get relief from their eye symptoms with oral allergy medicines such as Claritin®. However, a large portion of patients require topical allergy and anti-inflammatory drops. These drops concentrate the anti-allergy effect right in the eyes. In mild cases of eye allergies, I generally prescribe drops such as Pazeo® and Lastacaft®, which helps inhibit the action of histamine and even prevents certain cells from releasing it.

I also recommend using artificial tears. They help to dilute and wash away any pollens or allergens from the ocular surface. Patients can even refrigerate the tears, which gives a soothing sensation when they use them. In more moderate cases of allergic conjunctivitis, especially when the pollen counts are high, I will add a steroid drop to help suppress the immune response. This generally produces very quick relief of symptoms.

I would urge anyone suffering from allergies to seek medical treatment. Too often, I find patients taking over the counter “get the red out” drops, because they believe these are the only therapies available. These medicines generally don’t treat the problem at its source and only mask the symptoms. I also find that I have to directly ask my patients if they experience eye allergies. Many don’t report their ocular allergy issues because they feel it’s just the norm to endure the bad months when pollens are high and their symptoms are severe. Untreated, seasonal allergies can leave a patient miserable; however, with proper medicines, patients can enjoy the spring and summer months as they should.

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Monroe Township
Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777

Visit us anytime

Outlook Eyecare
100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920

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