Recently, I had a patient who complained of a drooping eyelid that kept recurring. He informed me that the eyelid got droopy and then better. It was often worse at night. He also had double vision. He had seen several specialists without figuring out what the problem was.
After examining him in the office, I performed a simple test with a pack of ice. As an oculoplastic surgeon in Denver, treatment of drooping eyelids are one of the main things that I do. Often that means surgical correction where muscle or skin needs to be tightened. The most important thing to do as an eyelid specialist is to identify non surgical causes of drooping eyelids.
After having the patient place an ice pack on the eyelid, the eyelid immediately improved in appearance and lifted. If you can imagine it, there is no way that drooping eyelid from a structural cause such as aging will be fixed by a pack of ice. The patient was referred to his neurologist for treatment of myasthenia gravis.
Myasthenia Gravis is an autoimmune condition characterized by antibodies in the blood. Patients with Myasthenia can have it isolated to the eyes or even in the body. Patients with myasthenia gravis in the eyes need to be checked for body myasthenia. Myasthenic patients need to be treated with mestinon, a medication to counter the antibodies in the blood stream working against muscle function. Sometimes myathenic patients may even have a tumor in their chest called a thymoma.
When seeking an oculoplastic or eyelid specialist for a drooping eyelid it is critical to find a doctor who can identify more serious conditions and appropriately manage them. A mistake in this patient’s case would be to simply lift the eyelid surgically. The myasthenia gravis would be missed and would most likely recur. Additionally, if the patient had a tumor it would be missed. If the patient had body weakness it would be ignored.
There are blood tests for myasthenia gravis that can also be used. Treatment is not isolated to mestinon. Steroids can also be used. If you have a drooping eyelid come to our office to get checked out. There are more serious neurological causes which should be looked at before having surgery. Make sure you have a well experiences eyelid specialist who is well versed in neurological conditions that may masquerade as something more serious.