As of Wednesday, April 16, 2014
DEAR DOCTOR K: My right eyelid droops and interferes with my vision. What can I do about this?
DEAR READER: The medical term for a drooping eyelid is “ptosis” (pronounced TOE-sis). In severe cases like yours, the drooping eyelid can cover all or part of the pupil and interfere with vision.
Every part of our body is constantly tugged on by gravity. And something that is constantly being pulled downward (at least when we are standing or sitting) tends to sag. The eyelid is no exception. The effects of gravity can be exaggerated by any injury that weakens the strength of the eyelid.
What gives the eyelids the strength to open? Tiny muscles that get signals from specific nerves leading to those muscles. Any injury to the eye can weaken the nerves or muscles involved in opening the eyelids. A common nerve injury is caused by diabetes, for example. Sometimes Botox is to blame. This popular cosmetic procedure to eliminate wrinkles at the brow and forehead can cause temporary eyelid drooping.
Many people tend to develop one or more drooping eyelids as they grow older — without any particular medical cause being discovered. President Kennedy, for example, had one drooping eyelid. (A friend of mine said it gave him “bedroom eyes.” I think she was responding to the fact that he was a handsome man.)
Before trying any treatment for a drooping eyelid, you should have a medical exam. This will help identify the underlying cause. Ptosis resulting from disease usually responds to treatment of the disease. If the problem is caused by Botox injections, wait until the injections wear off. This takes about three to four months.
When age-related ptosis interferes with vision, a plastic surgeon usually can correct the problem. He or she will surgically raise your eyelid by removing excess tissue and lifting the lid. This usually can be performed as an outpatient procedure and is done under local anesthesia, which allows the surgeon to adjust the position of your eyelid while your eyes are open. Many health insurers will cover this operation if the ptosis is affecting your vision.
In most people, ptosis develops gradually and is not caused by a serious underlying medical condition. However, when ptosis develops suddenly — over days or weeks — it can be a warning sign of something more serious.
Several serious diseases can affect your eye muscles, nerves to the eyelids or eye socket. For example, ptosis can be one of the first symptoms of myasthenia gravis. This rare disorder affects the ways muscles respond to nerves. Ptosis that comes on suddenly can also result from a stroke, brain tumor or brain aneurysm. This requires immediate medical attention.
Over the years, I’ve seen many people with drooping eyelids. Fortunately, I’ve seen only one that I recall with the sudden development of ptosis caused by a serious underlying condition. So the likelihood is that your drooping eyelid does not indicate a serious problem.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.