Now, I propose the notion that lax eyelid skin in middle-aged and elderly people is one of the major causes of visual fatigue in patients. Why? When eyelid skin laxity occurs in the upper lid, it causes pseudo- or true ptosis, which obscures the visual axis, that is, behind part of the pupil, making the patient easily fatigued and experiencing visual fatigue. If it occurs in the lower lid, the patient may experience tearing and tear spillage, leading to dry eyes and visual fatigue. Therefore, it is important to pay clinical attention to the condition of eyelid skin laxity. This is an important cause of visual fatigue, narrowing of the visual field, and even vision loss in many middle-aged and older adults. Many middle-aged and elderly people with visual fatigue may be diagnosed by their doctor as having “dry eye” and advised to order a variety of artificial tears, but they still do not work. In this case, it is important to note whether the patient has lax eyelid skin that is blocking the line of sight (visual axis), as no amount of eye drops will solve the problem at all. The way to correct severe eyelid skin laxity is surgery. Therefore, I would like to make a special point here by saying that lid skin laxity surgery for middle-aged and elderly people is secondary to the need to meet the cosmetic needs, but more importantly, to solve the functional problem of visual fatigue.