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Drooping of the eyelids in a patient in Denver hiding a more serious condition

One of the most common procedures I perform are eyelid lifts in Denver. Eyelid lifts are done for several reasons and really represent a spectrum of different eyelid surgeries that are done to get the eyelids out of the way of the vision of a patient. Also, they are done to improve the eyelid and facial appearance.

One of the most important things I do before performing an eyelid lift is ruling out diseases that can cause drooping of the eyelids. If the eyelids are lifted but the underlying disease is not treated, not only can the drooping recur but the underlying problem can hurt the patient.

Lets look at the following case:

A patient was sent to me for a second opinion after a doctor wanted to perform an eyelid lift surgery on him. As can be seen in the photo, the patient has a drooping eyelid in both eyes. The pupil is partially covered on both sides. Also of note, his right lower eyelid is turning in rubbing eyelashes against the eye. This is called an entropion.

The second thing of concern is patient has a drooping eyelid with lashes pointing down. Lashes pointing downward is called “lash ptosis”. The drooping eyelid is often fixed with a ptosis repair surgery and that was recommended to this patient. That being said, the lash ptosis or eyelashes pointing down can reflect a more serious condition called “Floppy eyelid syndrome”.

Floppy eyelid syndrome is a disease of the eyelid associated with obstructive sleep apnea. Obstructive sleep apnea is a disease where patients can have trouble sleeping from their throat obstructing their breathing. Sleep apnea can cause heart failure over time from the lack of oxygen the patient is getting. The second photo shows the looseness of the eyelid on eversion or flipping. That is not a normal finding but seen in floppy eyelid syndrome.

Floppy eyelid if detected should initiate a workup for sleep apnea. In the second picture I am everting the eyelid of the patient. The stretch of the eyelid is noted. (Most patients eyelids do not stretch like this). As a result, this patient does have floppy eyelid syndrome and needs a sleep study workup for sleep apnea. Floppy eyelid can cause eye irritation and corneal damage if not identified.

The next step for this patient is sleep study workup to rule out sleep apnea. Sleep apnea is treatable with a breathing machine and other treatments. This should be done before the surgery so the drooping eyelid will not return after the eyelid is repaired. Most important because of the systemic risks of sleep apnea, it is important that it is identified. There is no point in fixing the eyelids of a patient and they die of heart failure or pulmonary hypertension because the sleep apnea was missed.

This case is a classic example of why knowledge of medical diseases of the eyelid, face and body are critical before performing surgery on the eyelids of patients. Even some cosmetic problems of the eyelids such as puffiness of the eyelids can reflect a systemic disease such as Graves disease. Going straight to surgery would be a mistake without looking at the underlying cause.

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