Ptosis of right eye on waking. What might this be? (Photo)

Question

My right eyelid is drooping when I wake very day for past two weeks, it was partially shut for first week but seems to be getting worse. It resolves within about a minute of waking. I also feel my eyelid getting heavy at night when I'm tired. Nothing I've read about ptosis talks about it only being on waking. Any ideas of what it might be?

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Typically, ptosis can change appearance during the day. Fatigue can worsen it. On occasion, it can be related to a medical condition. Please see an Oculoplastic Surgeon for comprehensive evaluation and guidance.Good luck,

David Cheung, MBChB, Bsc(Hons), FRCOphth · Answer

Hi Brawl. Greetings from the UK! Yes we get asked that a lot in the clinic. It's actually not that uncommon when you ask patients about it directly. We often get patients referred in for intermittent ptosis which is commonly on waking and when tired. Often the neurologists are questioning whether a patient has got myasthenia or ocular myasthenia in the presence of normal Acetylcholine receptor antibodies and then ask us to perform an ICE test to look for ocular myasthenia. More often than not it's due a to weird phenomenon where patients have a mild degree of dehiscence of the levator aponeurosis tendon of the eyelid e.g, due to ageing or contact lens wear. Because of this stretched weaker tendon, the levator muscle finds it more difficult to transmit its elevation force to the cartilage of the eyelid (tarsal plate). Normally it's not a problem and the patient doesn't therefore have a ptosis. However when the patient is tired or on waking in the morning the ptosis becomes manifest. The theory is that the surface of the eye is more dry on waking and this leads to increased friction between the tarsal plate and the ocular surface- hence you need increased elevation force on the tarsal plate to overcome this increased friction- hence the ptosis becomes manifest. As the surface of the eye becomes moist, the friction dissipates and the ptosis disappears. We sometimes give  patients with ptosis and dry eye, a trial of lubricants prior to any decision about ptosis surgery and weirdly enough sometimes their ptosis improves!.

Ptosis of right eye on waking. What might this be? (Photo)

Answers (2)

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