How Physical Trauma from Seizures can Possibly Cause the Eyelids to Droop (Ptosis)

Author: Amiya Prasad, M.D.

Thank you for your question. You state in your question that you’ve been dealing with something called “fits” for the past 9 to 10 years. But with medications, you are currently under control and that you are concerned about the left upper eyelid being lower than the right upper eyelid. Well, certainly I can share with you my approach to what I see with the photos and this is of course in the absence of a physical examination. A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. And dealing with eye asymmetry particularly with the condition called ptosis has been a very significant part of my career. And I think I can certainly share with you my approach to doing an evaluation and then recommendations.

So with the understanding that the term “fits” as you’re describing it is synonymous with the term seizures or epileptic seizure, I think that at least we can establish that you have had these seizures which required some medications to take under control. I would wonder if during any of these episodes, whether you had trauma that caused swelling of the eye area or bleeding or hematoma in these areas which would make me think of something like, as far as the difference in the position, as a trauma induced ptosis but let’s backtrack a little bit. The left upper lid being lower than the right upper eyelid, basically I refer to as ptosis. Ptosis meaning drooping and the ideology of ptosis is very important.

Is it caused by something, as described, trauma? Now in traumatic ptosis, what happens is there is a trauma, whether it’s a physical assault, a motor vehicle accident or something that causes a tremendous amount of swelling that can cause the muscle, the levator muscle, the muscle that lifts the eyelid to stretch or detach so that the eyelid droops. That’s traumatic ptosis. Then there is something called neurogenic ptosis which means there is a neurologic issue. Now this can’t be diagnosed with just photos alone. I would recommend that you see a neuro-ophthalmologist to check your eye movements to determine whether or not there are other eye muscle abnormalities that are occurring with the ptosis and whether further investigation or imaging would be indicated. Now that being said, I can tell you that the more common solution that we offer for ptosis that’s not neurogenic or caused by a neurological issue but is caused simply by the eyelid muscle being stretched or separated is basically ptosis surgery. And we do something where we actually move the muscle that lifts the eyelid whether we shorten it or move it forward and we reattach it.

And when we’re doing this, this is based on the examination and a ptosis evaluation. Now in a ptosis evaluation, basically I’m looking at the position of the eyelid, the eye muscle function by having the patient look down and look up. I’m looking at other ophthalmologically relevant features or signs and then I determine whether or not this is something that would be amenable to this type of surgery. When we do ptosis surgery, after the muscle is placed, I ask the patient to open their eyes, I have them sit up so I can look at their eyes when they’re sitting up and I make the adjustments necessary.

How Physical Trauma from Seizures can Possibly Cause the Eyelids to Droop (Ptosis)

And then we lay them back and we do this a couple of times until we get the satisfactory height, shape and contour to maximize symmetry. Basically, the golden rule is it should look good in the operating room otherwise, it won’t look good outside of it. Now, a certain percentage of people do need some type of enhancement whether it’s overcorrection or undercorrection but that’s part of the reality of doing this type of surgery. So I think it’s best for you to see an ophthalmologist or a neuro-ophthalmologist specifically first to rule out the other neurologic basis and to make sure that there are no other neurologic cause that needs to be pursued. Once that’s accomplished and you’re cleared of that, then an oculoplastic surgeon should be able to help you with the ptosis surgically. So I hope that was helpful, I wish you the best of luck and thank you for your question.

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How Physical Trauma from Seizures can Possibly Cause the Eyelids to Droop…

Thank you for your question. You state in your question that you’ve been dealing with something called “fits” for the past 9 to 10 years. But with medications, you are currently under…

By: Amiya Prasad, M.D.