Eyelid drooping: symptoms and causes

2021-01-26 12:00 AM

Eyelid drooping is a sign of muscle weakness or a connective tissue disorder of the eyelids. Lash due to muscle weight is caused by the separation of the lifting muscles and connective tissue at the site of the ciliary cartilage.

Description

Eyelash droop is an abnormal drooping eyelid. Can happen on one or two sides. Normally, the upper lids cover 1–2 mm of the upper iris, and the lower lash reaches the lower margin of the iris.

Causes

Common

Horner syndrome.

Common intraocular motor neuropathy (CNIII).

Lashes due to muscle weight.

Sagging eyelids.

Less common

Myasthenia.

Dystrophy increases muscle tone.

Mitochondrial myopathy.

Figure. Dystrophy increases muscle tone with 'plough face' and drooping lashes on both sides

Figure. Myasthenia gravis before and after edrophonium test showed bilateral drooping, more severe left side

Figure. Anatomy of the eyelid muscles

Mechanism

Causes of eyelid collapse include:

Horner syndrome.

Common optic nerve paralysis.

Nerve-muscle joint disorder.

Dystrophy increases muscle tone.

Mechanical disturbances in the connective tissue around the eye.

Horner syndrome

Horner's syndrome is caused by damage to the sympathetic pathway, the neuromuscular distribution of the upper cartilage (Müller's muscle), the ray muscle of the iris, and the sweat glands on the face. Weakness of the upper ciliary cartilage causes eyelid collapse in Horner syndrome.

Paralysis of the common ligament (CNIII)

The upper lash lift muscles are dominated by the parasympathetic bundles of the common ligament. Joint ligament paralysis causes eyelid collapse by weakening the upper lash lift muscles.

Neuromuscular junction disorder

Myasthenia gravis is an autoimmune disorder characterized by antibodies against the post-synaptic acetylcholine receptors at neuromuscular junctions. The external and facial muscles are affected mainly. In myasthenia gravis, the more muscle is used, the weaker the muscle is (fatiguability). In addition, muscle weakness can be reversed if the temperature of the muscle drops, which can be demonstrated with the 'ice to eye' test in bed.

Muscle dystrophy increases the tonicity

Unlike most other primary muscle disorders (myopathy), hypertonic muscular dystrophy causes weakness in facial and peripheral muscle groups. Other signs of hypertonic muscular dystrophy include increased tonicity when typing and performing a grip.

Mechanical disturbances of the connective tissue around the eye

Lash due to muscle weight is caused by the separation of the lifting muscles and connective tissue at the site of the ciliary cartilage. Local swelling and degenerative changes in the skin and soft tissue of the cartilage can cause eyelash collapse. Eyelid drooping is caused by excess upper eyelash tissue causing drooping of the eyelids.

Meaning

Eyelid drooping is a sign of muscle weakness or a connective tissue disorder of the eyelids.