Lazy eye or ptosis? (Photo)

I’m a cosmetic oculofacial plastic surgeon.
This means that my first area of specialty training was in eye surgery and then
I went on to do specialized training in cosmetic and reconstructive surgery of
the eyelids, orbit, and lacrimal system. I’m also board certified in full body
cosmetic surgery by the American Board of Cosmetic Surgery. I’ve been in
practice for over 20 years and I can certainly tell you that lesions around the
eyes and ptosis or drooping of the eyelids are things I deal with every day in
our practice.



When I looked at your photo, the left eye in
the inner aspect appears to be lower compared to the right eye. When we make observations, we want to ask
further questions in a consultation. In our practice, we ask about history and if
you looked at previous photos and saw that difference. We try to differentiate
if this drooping is congenital or you were born with it or if it is acquired or
something that has occurred later.



If you were born with the drooping eyelid, at
certain points of your life, that drooping eyelid can be a little lower.
Sometimes patients compensate for the asymmetry naturally,
which eventually leads to a bit of a further descent. This descent can only be
a millimeter but it can make enough of a difference. Within the normal
population, it’s normal to have a difference between the two eyelids of about
1-2 millimeters. The human body is asymmetric so we generally tolerate that
without it drawing attention. When it’s greater than that, it usually prompts people
to seek professional attention.



I would say that you would need proper
examination and diagnosis. In my practice for over 20 years, I have performed
all kinds of ptosis surgeries from congenital or people born with it, for
helping people with vision, acquired ptosis, myogenic ptosis or muscle-related
ptosis. These are all different types of ptosis and there’s always a difference
in the way you approach them based on some objective parameters that are
determined during physical examination. So clearly, you need to meet with a
doctor in order to get the proper evaluation of this concern.



Generally, people first see an ophthalmologist
or someone from my specialty, an oculoplastic surgeon and try to determine what
the cause is. We also want to rule out neurologic causes which can be
determined by a neuro ophthalmologist. As long as you find one specialist to
evaluate you, you should be led from that one point forward in the right
direction.



As far as the lesion is concerned, although
this is not a high resolution photo, I believe you are referring to a lesion in
left lower eyelid along the margin. Although I can’t see exactly, it appears to
be from a general perspective a nevus or a bump-like a freckle that you’re born
with. Again, without a physical examination and without a 3-dimensional view,
it’s really not appropriate to diagnose that without qualifying it. Again,
meeting with a specialist is important to get the proper diagnosis. I hope that
was helpful, I wish you the best of luck, and thank you for your question.



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It's always difficult to make a diagnosis based on photos but from what you've submitted, it appears that you have a mild ptosis (droopy eyelid) on the left side.  It looks worse than it measures, most likely, because the eyelid crease on that side is higher than it is on the right side, and that is very typical.  Therefore, to correct this, the surgeon needs to address both the height of the eyelid, based on the measurements we take in the office, as well as the position of the crease, for optimal results.  During testing in the office, the doctor should explain that there is an approach for surgery where an incision is made in the eyelid crease as well as an approach from under the eyelid where the incision is hidden and which procedure would give you the best result.  One is called an external levator advancement and the other a Fascenella-Servat procedure.Seek out a board certified oculofacial plastic surgeon in your area for this type of delicate surgery.I hope that helps and best of luck.