Uneven Eyelids Ptosis? Lazy Eye? (photo)

Ptosis refers to drooping of the upper eyelid.  Eyelid position is a very complex mechanism, it is determined by the shape of the eye and face, function of the muscles that lift the eyelid, vision, height of the oppposite eyelid, and an intact nervous system.  From your pictures, it appears as if you have ptosis of the left upper eyelid, which can affect the right upper lid crease depending on how droopy the left upper lid becomes during the day and as you get tired.  The most important thing would be to first determine the cause of the drooping eyelid because there are certain medical conditions that can change the eyelid position, that are treated medically not surgically.  Once the cause has been established, if surgical correction is desired, the eyelid can be lifted into the optimal postion to improve the symmetry and improve the lid crease height on the opposite eyelid.  A good place to start is with an evaluation by an ophthalmologist to give you a complete eye exam, then to surgical specialist, such as an oculoplastic surgeon (an ophthalmologist who trains in plastic surgery as it pertains to the eyes and face) who performs ptosis surgery.  

You have classic ptosis of your left eyelid.  This can be do to muscle weakness of something called the levator muscle or the Muller's muscle.   Another possibility is poor connections from your levator muscle to certain structures of your eyelid that hold it open.  This would account for your lack of a crease on the left or the high crease you have.

How does this affect your right eyelid?  I'll tell you.  The weakness in your left eyelid is recognized by your left eye and brain.  The brain sends a signal to both eyes saying "open wider".  The left can't really respond and your right responds too well.  So it looks higher and the crease looks deeper and asymmetric.  It's called Herings Law

How do you treat this?

You would want to do a ptosis repair on the left eyelid but only after you've done a patch test.  Cover your left eye for an hour with a gauze.  Don't let any light in.  See how much your right eye corrects on its own.  That will tell me how big or small of a surgery to do on the left.

The left eyelid can be corrected via an external incison (most reliable).  You would have a small incision that would heal great.  Other option is to do with through the underside of your eyelid.  Advantage is you don't have an external incision.  Disadvantage is it may not move your lid up enough.

Dr. Chase Lay