The "before" and "after" pictures of her eyes make the problem seem pretty obvious, but, like many people, it happened so gradually that Ellen Keele didn't understand how bad it was.

"It's just for years my eyelids were slowly covering my irises," the 66-year-old Bradenton resident said. "The more they were covered, the less I could see well."

She had stopped driving at night and was very careful when she drove during the day, yet she hadn't fully realized that she might need surgery. Keele went for an eye exam, hoping new glasses would improve her vision.

The optometrist had to hold her eyelids open for the exam. When she had her annual physical checkup, the same thing happened.

That's when she said, "I've got to go to a specialist."

Enter Dr. Eric Berman, an oculoplastic surgeon at the Manatee-Sarasota Eye Clinic & Laser Center. He performed surgery on Keele's eyelids in May.

He said people with drooping eyelids are not quite aware of when surgery is needed because it is a "slowly progressive problem." They compensate by raising their eyebrows to lift their eyelids. Sometimes, he said, the "eyebrows are halfway up the forehead."

Aging is the most common reason for the lowered eyelids, Berman said, but swelling from allergies and inflammation from previous surgeries are also causes. The American Academy of Ophthalmology lists injury and diseases that affect the levator muscle (the muscle that lifts the eyelid) or its nerve supply as additional reasons for drooping lids.

Both drooping lids and excess, stretched skin of the upper eyelids can interfere with vision. Specialists like Berman remove the excess skin and muscle and make necessary repairs to the eyelids with the goal of improving the patient's vision.

That's exactly what happened with Keele and Pamela Nova, 52, also of Bradenton.

Nova said prior to her outpatient surgery, "I virtually couldn't see." She explained that her eyelids were "well below the middle of my eye and the weight of the eyelid caused my eyelashes to grow inward." Because of this, she felt like she had sand in her eyes constantly.

Nova said after the surgery "my vision came back completely clear."

Despite "fairly extensive work," she said there was "no pain in the healing" and she had the "most minimal of bruising."

Berman said recovery time varies depending on the surgery, but "generally speaking, we're talking one to two weeks." Patients will have swelling and bruising that they can disguise with makeup after the first week.

Some may have trouble completely closing their eyes, but this is usually temporary, according to the American Academy of Ophthalmology.

Neither Keele nor Nova experienced complications. These can include bleeding, infection, loss of vision and unevenness in the appearance of the eyes.

Even though the surgery is performed for significant visual impairment rather than cosmetic reasons, a changed appearance is one of the results of the surgery.

Keele described her daughter's reaction. "After surgery and I began healing, it was such a dynamic change on my face. My daughter just stared at me. 'Mom, you look so different.' She was thrilled.

"I am so, so grateful. Anyone would be. . . . Thank God we have specialists that know what to do."