Acıbadem Ataşehir Hospital Neurology Specialist Assoc. Dr. Pınar Kahraman Koytak made a statement about droopy eyelids. A tired, sleepy and exhausted facial expression… Although droopy eyelids are generally seen as an aesthetic problem, it actually brings along functional problems that can seriously reduce the patient's quality of life. So much so that the falling lid can prevent vision by covering the pupil. As a result, patients often have to raise their eyebrows to see, or even tilt their heads back in later stages of miscarriage. 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.
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 delay the diagnosis and treatment of a possible risky neurological disease. said.
Assoc. Dr. Pınar Kahraman Koytak touched on the symptoms that need attention
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. Pinar Kahraman
Koytak describes other symptoms to be careful about as follows: “In addition, if there is a drooping eyelid that changes during the day, for example, which increases significantly towards the evening, if the drooping eyelid changes sides or if it is accompanied by other complaints such as double vision, fatigue, muscle-nerveness such as myasthenia gravis. A detailed neurological evaluation is absolutely necessary in terms of junctional diseases.”
Dr. Pınar Kahraman Koytak warns of 3rd nerve palsy symptoms
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.
Koytak emphasized that attention should be paid to Horner 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 can also be associated with tears such as carotid dissection.
Assoc. Dr. Pınar Kahraman Koytak stated that 'muscle-nerve junction' diseases should not be missed in the diagnosis and made the following statement:
“In such diseases such as myasthenia gravis, although the muscles and nerves are normal, 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.
Assoc. Dr. Pınar Kahraman Koytak made a statement about Myasthenia 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.
Koytak also touched on muscle diseases that can occur around the eyes.
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.
Neurology Specialist Assoc. Dr. Pınar Kahraman Koytak stated that droopy eyelids in adults are most commonly caused by the loosening of the connective tissue in the muscle that lifts the eyelid or its separation from the place where it is attached, and continued as follows:
“This dissociation can develop due to many factors such as thinning of tissues with aging, use of contact lenses, trauma to the eye, eye surgeries, and constant rubbing of the eyelids. Infectious or inflammatory diseases and tumoral formations that put a load on the upper eyelid can also cause droopy eyelids. In addition, botulinum toxin applications applied to the eye area and forehead muscles for cosmetic purposes can also cause droopy eyelids due to temporary muscle-nerve junction conduction failure. This situation is temporary and improves when the effect of the drug wears off.”
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