A droopy eyelid can make it risky for patients to drive, do sports, walk and even do simple daily tasks. In order to get rid of their problems, patients are knocking on the doors of physicians for ‘eyelid aesthetics’ surgery.
LOW EYELID CAN BE A SYMPTOM OF SERIOUS DISEASES!
Acıbadem Ataşehir Hospital Neurology Specialist Assoc. Dr. Pınar Kahraman Koytak, pointing out that before planning any medical or surgical treatment in droopy eyelids, however, a detailed evaluation should be made for the cause, “Because droopy eyelids are caused by the muscles around the eyes responsible for lid functions, the nerves that feed these muscles, or the centers in the brain where these nerves originate. It can be caused by any neurological problem or disease that affects Surgical treatments without excluding these diseases may not be satisfactory and may lead to a delay in the diagnosis and treatment of a possible risky neurological disease. says.
SYMPTOMS OF LOW EYELID
If the drooping eyelid has started especially suddenly, if this problem is accompanied by double vision or a change in pupil size, or a headache, it is necessary to consult a doctor without delay. Because these symptoms can be associated with some important cerebrovascular pathologies that require urgent diagnosis and treatment, as in third nerve palsy or Horner’s Syndrome. Assoc. Dr. Pınar Kahraman Koytak describes other symptoms to be careful about: -Detailed neurological evaluation is absolutely necessary in terms of nerve junction diseases.
PROBLEMS CAUSED BY THE BRAIN AND NERVE
It occurs as a result of the nerves responsible for eyelid functions being affected by factors such as trauma, ischemia or pressure in the regions where they originate in the brain or during their course.
Nerve Paralysis
If the droopy eyelid is accompanied by double vision, if there is strabismus or dilated pupil on the affected side, the cause may be third nerve palsy. This table; It may occur as a result of diabetes, high blood pressure, trauma or a stroke in the area of origin in the brain stem, vascular occlusion or lesions such as a mass.
HERNER SYNDROME
In Horner’s Syndrome, there is narrowing of the eyelid space rather than drooping of the lid, and a narrowing of the pupil on the same side is observed. Horner Syndrome can be a symptom of many important diseases affecting the relevant anatomical regions, including lung cancer, due to the long course of the nerve fibers involved in the brain, spinal cord, and even in the thorax. Neurology Specialist Assoc. Dr. Pınar Kahraman Koytak said, “Especially if it develops acutely or is accompanied by headache and changes in pupil size, droopy eyelids should be evaluated with emergency neuroophthalmological examination and neuroradiological examinations. Because, with vascular compressions such as third nerve palsy, life-threatening aneurysm; Horner syndrome, on the other hand, can be associated with tears such as carotid dissection.”
MUSCLE-NERVE JUNCTION DISEASES
It is very important that ‘muscle-nerve junction’ diseases should not be missed in the diagnosis, as they are more common than other neurological causes, can be treated with medication, and should be excluded before valve surgery is planned. Assoc. Dr. Pınar Kahraman Koytak said, “Even though the muscles and nerves are normal in such diseases as myasthenia gravis, there is a problem in the conduction at the muscle-nerve junction due to a problem related to the immune system. As a result, the muscle cannot function properly, and muscle weakness and fatigue are seen, which is variable, increasing with fatigue – improving with rest.
MYASTENIA GRAVIS
Since the muscles around the eyes are the most frequently and earliest affected muscles in muscle-nerve junction diseases such as myasthenia gravis, patients usually first apply to the physician with complaints of drooping eyelids and/or double vision, which increases towards the evening. In addition, weakness in the arm and leg muscles, difficulty in swallowing, speaking, chewing, and even breathing may occur. “These findings are very important and may be related to the emergency clinical picture called myasthenic crisis, which progresses with respiratory failure,” said Assoc. Dr. Pınar Kahraman Koytak said, “Therefore, close and regular follow-up of patients is required. The disease is often well controlled with immune therapy options. If it is associated with a malignant tumor of the thymus gland in the rib cage, the gland needs to be removed with early surgery.” It is sometimes difficult to diagnose patients with ocular myasthenia in which only the eye muscles are involved, because it can be confused with mimic diseases. Advanced electrophysiological examinations such as single fiber electromyography are very helpful for definitive diagnosis.
MUSCLE DISEASES (MYOGENIC CAUSES)
Muscle diseases in which the muscles around the eyes are affected (such as progressive external ophthalmoplegia and mitochondrial myopathies, myotonic dystrophy) are usually genetically caused. The droopy eyelids are mostly bilateral and symmetrical, and some may have severe limitation of movement in the eyes. In addition to these, weakness or contraction of the arm and leg muscles, difficulty in swallowing and systemic findings may also occur. In these cases, which are very rare, it is of great importance to question the family history well, to evaluate with advanced examinations, especially with detailed neuroophthalmological and neuromuscular examination, electromyography and genetic examination.