Upper eyelid sulcus: the hollow, sunken look
- Highlighted area
Quick facts
- Definition
- A depression between the upper rim of the orbit and the upper eyelid, giving a sunken-eye look.
- Location
- Below the eyebrow and above the crease of the upper eyelid.
- Common causes
- Loss of eyelid fat with age, weight loss, previous blepharoplasty, eyelid ptosis and glaucoma eye drops of the prostaglandin class.
- Warning sign
- Hollowing on one side only, recent or with visual change, which calls for ophthalmologic assessment.
- Relevance in HOF
- High vascular risk region, close to arteries linked to the circulation of the eye.
The hollow upper eyelid sulcus is the depression between the upper rim of the orbit and the upper eyelid, which gives the gaze a sunken and tired look. In English it appears as superior sulcus deformity or "A-frame", because of the angled shape the hollowing forms. It can come from aging, weight loss, previous surgery, eyelid changes or medications, and part of these causes is a matter for ophthalmology, not HOF.
Sulcus or crease: what is the difference?
The term is confusing because "upper eyelid sulcus" is also used for the eyelid crease, the line where the skin folds when the eye is open. On this page, the topic is the hollowing above that crease. A very high crease, together with hollowing, may point to a problem in the levator palpebrae muscle.
What are the causes of a sunken eye?
| Cause | How it usually appears | Who assesses first |
|---|---|---|
| Aging | Bilateral, gradual, with loss of fat behind the orbital septum and widening of the bony orbit | HOF or surgeon, after assessment |
| Marked weight loss | Bilateral, together with volume loss in other regions | HOF, with a global assessment |
| Blepharoplasty with fat removal | After surgery, sometimes asymmetric | The surgeon who operated |
| Eyelid ptosis from levator disinsertion | Lower eyelid, high crease, deep sulcus | Ophthalmologist |
| Prostaglandin analog eye drops (glaucoma) | Hollowing, sometimes more in the treated eye | Ophthalmologist |
| Enophthalmos (eye sunken back in the orbit) | Unilateral, sometimes after trauma | Ophthalmologist or surgeon |
Why does it matter in HOF?
- Scope limit: hollowing on one side only, recent, with a drooping eyelid, double vision or after trauma is not an aesthetic concern until proven otherwise. Referring is part of a responsible assessment.
- Vascular risk: the region lies close to the supraorbital and supratrochlear arteries, branches of the ophthalmic artery. Embolization in this territory can reach the circulation of the retina.
- Expectation: a tired look usually has several causes at once (low eyebrow, excess skin, bags). The global assessment is in tired look.
How does it show up in the assessment?
- Symmetry: compare both sides in a standardized front photo.
- Eyelid position: check whether the eyelid margin covers more of the iris on one side.
- Medications in use: ask about eye drops, especially for glaucoma.
- History: eyelid surgeries, facial trauma and recent weight loss.
The area is covered in periorbital.
Also called: sunken eye, hollow upper eyelid, sunken gaze, superior sulcus deformity.
Frequently asked questions
Why does the upper eyelid look hollow?
The most common causes are loss of eyelid fat with age, weight loss and removal of fat in eyelid surgery. Eyelid ptosis, the use of some glaucoma eye drops and changes in the orbit can also hollow the area, so the cause must be investigated.
Can a sunken eye be treated with filler?
Filler in the area has been described in selected cases, but it is a high vascular risk area, close to arteries linked to vision. The indication depends on the cause, and often the first step is an ophthalmologic assessment.