Should I get a 2nd opinion on droopy eye from another ophthalmologist, or go directly to a specialist in ptosis repair? (Photo)

Question

My left eye become inflamed and droopy during a sinus infection a month ago. An ophthalmologist gave me oral antibiotics and an antibiotic/steroid ointment applied directly to the eye. The inflammation went away quickly, but the droopiness hasn't changed. He says he can't see a stye, so "probably" the levator muscle was damaged so the droopiness won't go away. Besides a followup in 3 months, he says there is no other way to treat me. 46 year old male, otherwise good health.

Kenneth D. Steinsapir, MD · Answer

Sinus infections affect eyelids when infection spreads into the orbit.  These are almost always pretty serious.  A swollen eyelid and a history of sinus infection must be assessed with a CT scan to assess the status of the sinus and the presence of frank orbital abscess. Assume the sinus is properly treated ( and this may require sinus surgery) and there is no orbital abscess, the ptosis can take up to 12 months to resolve.  The resolution may be complete or only partial.  I would advise extraordinary patients with this droopy eyelid.  They can fully recover on their own so it makes no sense to be in a hurry to surgically fix the eyelid.  One the eyelid has stabilized, it may require surgical attention to correct any residual ptosis.  I would not recommend allowing your general ophthalmologist or otolaryngologist to repair upper eyelid ptosis.  This is best left to the subspecialty oculoplastic surgeon who should be board certified in ophthalmology and fellowship trained in an American Society for Ophthalmic Plastic and Reconstructive Surgery accredited fellowship.

William Marshall Guy, MD · Answer

Hello Lakerone,It would be extremely rare for a sinus infection to create a permanent ptosis.  If it were caused by a sinus infection, then a topical antibiotic would have had no improvement.  Without an open wound, then topical antibiotics don't really do much for swollen tissue.  I would recommend that you see an ENT for evaluation.  This way you can be worked up for your sinuses.  If the sinus is still infected it can affect the appearance of the eye.  Once it is verified the infection is gone, it can still take awhile for the eyelid to look normal.  I personally had an eye infection two years ago and even after my infection was gone, it took over a month for my eyelids to look completely symmetric.  If for some reason you do have a permanent ptosis, then seeing an oculoplastic surgeon would be the best option.I hope this helps and good luck.

Raghu Athre, MD · Answer

I have never seen a persistent ptosis after an orbital cellulitis.  I would:1.  Check with an ENT to do a CT scan and r/o persistent sinus disease2.  Give the area a few weeks to heal3.  If it does not resolve and all imaging tests are (-), then I would consider ptosis surgery

Should I get a 2nd opinion on droopy eye from another ophthalmologist, or go directly to a specialist in ptosis repair? (Photo)

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Should I get a 2nd opinion on droopy eye from another ophthalmologist, or go directly to a specialist in ptosis repair? (Photo)

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