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 ageing. 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 Mr 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 went under the knife 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 the Sunday Times this week.
Mr 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, which is widely available on the NHS, simply involves making the muscle shorter. 'It's known as an anterior levator repair,' says Mr 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.'
However, it is possible to tighten the muscle too much, which can make closing the eye difficult - sometimes it's even impossible to blink completely which can make the eye dry and painful.
Occasionally the muscle isn't tightened enough. 'Both these problems can be easily corrected. Though it does mean having more surgery,' warns Mr Sandy.
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. This is often performed on children who are born with the condition.
'In this operation we attach extra tissue to the muscles in the brow and the patient uses their brow muscles to open their eyes,' says Mr Sandy.
The choice of operation really depends on the cause of the ptosis, so before you take the plunge, your eye surgeon would do a full examination to ensure there are no underlying causes that need treating. If you think your lids need looking at, ask your GP for a referral to a local eye surgeon. But be warned - not everybody who has problems opening their eyes in the morning is suitable for surgery.
'We can help almost everybody who sufferers from ptosis, but we have to justify the operation on medical grounds,' says Mr Sandy. 'If we operated on everybody who simply wanted the appearance of their eye lids improved, we'd be inundated.'
Most GPs will refer you for surgery if the lid droops so much that it covers part of your pupil and interferes with vision or causes other symptoms such as headaches.
