Lazy eye or ptosis? (Photo)

Ok, so i am trying to figure out what is wrong with my eye, to me it looks like one is bigger than the other and one my eyelid i have these small wart looking things that i cannot figure out what it is. Please help.

Doctor Answers 6

Asymmetry

Looking at your eyes and eyelids, you do have some asymmetry. We all have some facial asymmetry to an extent.

The most obvious thing, as others have noted, is the ptosis (or "drooping") of the left upper lid compared to the right side. The upper lid crease is also higher on the left, commonly seen when a lid is droopy. The other asymmetric finding I see is that there is more "white" showing above the left lower lid (compared to no "white" showing on the right). Since your lower lids look to be in similar positions, this could be due to a difference in the position of the eyeball itself. The combination of these findings lead to the overall asymmetry.

My recommendation would be to see an oculoplastic surgeon for a detailed exam to more thoroughly investigate these issues. Surgically repairing the droopy lid alone may sufficiently address the asymmetry. Your surgeon will give his/her opinion and discuss with you all of your options.


Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

You likely have ptosis, but you do need a physical evaluation by a specialist to determine its specific cause and treatment

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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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Asymmetric eyes

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.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 64 reviews

Eyelid ptosis

This appears to be ptosis from the photos but an in person evaluation is necessary.  I would recommend evaluating old photos with your doctor to see when this started or if it is congenital.  Also need medical history including any thyroid issues and would need to measure eyelid muscle function.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 20 reviews

Ptosis

Thank you for the question. Your right eyelid is higher than your left lid. You aware of this "ptosis" and could have surgery to lift the left eyelid. A "lazy eye" refers to misalignment of the eyes. It is difficult to see the bumps in the photograph. I recommend in office evaluation by a board certified oculoplastic surgeon who can guide you in the right direction for a treatment plan which is tailored to you. I hope you find this helpful.

Not lazy eye!

Lazy eye refers to strabismus or misalignment of the eyes.  That is not your issue.  The photo shows predominantly left upper eyelid ptosis but the right upper eyelid also looks a bit heavy.  I suspect that a detailed consultation will show that both upper eyelids are heavy but the left side is heavier than the right.  I recommend seeing a fellowship trained oculoplastic surgeon for this issue.  The American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a geographic directory on their website that can help you find a well qualified surgeon close to home.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.