This patient woke up with sudden drooping of the left eyelid. Originally she thought it was due to contact lens problem when the contact lens may have irritated the eyelid or eye. After going to several doctors without a solution, she came to my office it was noted her pupil was smaller in the left eye compared to the right. Instead of it being imple issue which is related to contacts or aging of the eyelid this in fact pointed towards a more serious neurological issue causing drooping of the eyelid. The patient was sent to emergency room and had a cat scan done which revealed a small aneurysm near in her brain pressing on the nerve that supplies the eyelid of the people. Horner's syndrome is a disease characterized by damage or pressure to the sympathetic nerves which run from the brain down to the lung back up to the brain through the neck. This is a serious condition which is requiring immediate imaging. One of the most important things that can cause Horner's syndrome are aneurysms and brain tumors, however Horner syndrome can be caused by multitude of causes such as chiropractic manipulation, trauma to the neck, central line placement and surgery. Patients who were in car accidents or who have whiplash from an amusement park ride can even get a Horner's syndrome. One of the most important things if you have a drooping eyelid is to rule out neurological issues that can cause this problem. An oculoplastic surgeon who is also neuro-ophthalmologist can look and make sure that there is not something more serious going on such as Horner's syndrome, Myasthenia graves or Graves' disease. There are other diseases that require medication treatment and are not treated with just simple surgery. If you need to surgery that is something that your oculoplastic surgeon like me can perform and put the eyelid to a more appropriate position. For patients with Horner's syndrome Muellerectyom or tightening of a muscle inside the eyelid is the approach that is preferred by myself. That being said, there are several approaches that can work well patients who have Horner's syndrome
The procedure to tighten the muscles is an outpatient procedure that takes 30 minutes with a one-week recovery. The success rate is roughly 96% which means 4% of patients will need adjustment or touchup to get the eyelid to a higher or lower position depending up healing. The pupil size difference cannot be fixed.
If you have a sudden drooping of the eyelid is important to see your eye care provider and get this checked out immediately. With the proper exam it can reveal something as simple as a displaced contact lens or something more serious such as a Horner's syndrome. Immediate imaging or testing would reveal aneurysm or tumor which would be obviously treated immediately. Call our office if you've any questions and like to schedule a consultation.