Uneven Eyelids Ptosis? Lazy Eye? (photo)

Question

When I was a child I had even eyelids, even eyes, as I got older I notice my left eyelid was normal, but the eye itself was droopy, and my right eyelid decided to be all weird and the fold itself became smaller, it would not fold right at the end of the eye, I will include a picture, but i have days idk how this happened, that my right eyelid folds correctly and looks normal but my left eye still looks droopy. How can i make my left eye open up more, and my right eye lid to fold normally?

Cameron Chesnut, MD, FAAD, FACMS · Answer

I would recommend a full examination and evaluation - be careful about who you choose to take care of this. We would need to determine if you actually have an issue call ptosis in your upper lid, which can cause asymmetry as your body tries to compensate, which affects both lids.  Any upper lid surgical procedure that does not attempt to address this, like a standard blepharoplasty, could likely make things worse, but some simple modifications to that technique can yield beautiful results. 
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Richard J. Bruneteau, MD · Answer

Your pictures and history demonstrate the presence of a unilateral left sided eyelid ptosis. This situation occurs when the muscles that elevate the eyelid become detached or weakened. This results in the left sided droopy eyelid phenomena that you describe. It's not unusual for this problem to occur unilaterally.When patients develop unilateral eyelid ptosis, the opposite eyelid has a sympathetic response that results in the eyelid being elevated to a higher than normal level. This is the open eye phenomena that you describe.Repair of eyelid ptosis can be performed under general or local anesthesia. A variety of techniques can be utilized to correct this problem. The technique chosen will depend upon the patients specific anatomic deformity.If you're concerned about eyelid ptosis, consultation with a board certified plastic surgeon is appropriate. This surgeon should be able to outline a treatment plan that addresses your anatomic deformity and achieves your aesthetic goals.

Jed H. Horowitz, MD, FACS · Answer

from the photos it is difficult to say.. you should see an oculoplastic surgeon or plastic surgeon with experience in ptosis repair. the problem may be on the left side only .. the muscle may not be working well or need to be tightened this will change the fold position. but the right side may needs some treatment as well

Boaz J. Lissauer, MD · Answer

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.

Chase Lay, MD · Answer

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

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