The condition of eyelid muscle weakness with fluctuating ptosis, characterized by intermittent symptoms, incomplete eye opening, and droopy eyes, can be caused by various factors such as immune system abnormalities, thymus gland disorders, and so on. These causes can be treated with medication.
Table of Contents
- What is eyelid muscle weakness?
- What is MG (Myasthenia Gravis)?
- Symptoms of MG (Myasthenia Gravis)
- Diagnosis and treatment methods for MG affecting the eyelid muscles
- Treatment of MG (Myasthenia Gravis)
- Differences between eyelid muscle weakness and MG
- Is eyelid muscle weakness dangerous if untreated?
- Differences between correcting eyelid muscle weakness and double eyelid surgery
- Side effects after eyelid surgery
- Surgical outcomes for correcting eyelid muscle weakness
What is eyelid muscle weakness?
It is a condition where the eyelid or the skin of the eyelid droops more than normal because the muscles that lift the eyelid do not work fully. This causes the eyelid muscles to be weak and unable to support the eyelid properly. Opening and blinking the eyes involve coordination between the eyelid, nerves, and eyelid muscles. This condition can occur in any gender and at any age. Some patients are born with it, while others develop it due to aging or prolonged use of contact lenses. Eyelid muscle weakness can affect one eye or both eyes. Patients with this condition often have symptoms such as sleepy-looking eyes, droopy eyelids, and dull eyes, which impact appearance, vision, and daily life significantly. Many people choose surgery to treat these symptoms.
What is the function of the eyelid muscles?
The eyelid muscles are responsible for closing, opening, or widening the eyes to protect them from potential harm. Blinking helps spread tears evenly across the eyes, which not only reduces irritation but also protects the conjunctiva and the cornea. The eyelids have eyelashes, which, besides adding to appearance, serve to prevent foreign particles from entering the eyes. Eyelashes are very sensitive; when something stimulates the area near the eyes, blinking occurs automatically as a reflex.
Common abnormal symptoms
Commonly found inflammation of the eyelid glands, often known as a “stye.”
- Eyelid muscle twitching occurs when the muscles around the eyelid contract involuntarily and can affect both the upper and lower eyelids.
- Eye muscle fatigue results from prolonged use of the eyes, leading to tiredness.
- Eyelid muscle weakness is caused by abnormalities in the eyelid muscles.
What causes eyelid muscle weakness?
Currently, there are many factors that cause vision problems, one of which is “eyelid muscle weakness,” which can affect people of all genders and ages. Some individuals even have these symptoms from birth, and lifestyle factors today can also contribute to this condition.
- Genetic inheritance
Eyelid muscle weakness in children is caused by underdeveloped eyelid muscles or inherited genetic traits. It is often observed that there is no eyelid crease, causing droopy eyes and difficulty opening the eyes fully. One eye may have poorer vision than the other. The drooping eyelid can cover the eye and block vision. If untreated, this can lead to lazy eye (amblyopia) or crossed eyes (strabismus). Symptoms of eyelid muscle weakness in children usually become apparent around 1-2 years old. - Aging
With increasing age, the skin structure of the eyelids becomes loose, and the eyelid muscles lose elasticity due to prolonged use. The strength of the eyelid muscles decreases, causing eyelid muscle weakness. The eyelids droop over the cornea more than normal, blocking vision. - Prolonged use of contact lenses
Contact lenses can rub against the upper conjunctiva, causing tears and injury to the eyelid muscle fibers, resulting in muscle weakness. - Patients with myasthenia gravis
Myasthenia gravis is a muscle weakness disease caused by abnormalities in the immune system, which affect neurotransmitter function at the junction between nerves and muscles. Common symptoms include:
– Eyelid muscle weakness causing ptosis, difficulty opening eyes, abnormal eye movements, blurred vision, and double vision
– Eyelid muscle weakness causing ptosis, difficulty opening eyes, abnormal eye movements, blurred vision, and double vision
– Weakness in arm and leg muscles
– Weakness in respiratory muscles leading to fatigue and shortness of breath - Daily lifestyle
Modern lifestyle habits involving extensive use of technology can contribute to eyelid muscle weakness. This includes people who work long hours in front of computers or use tablets and smartphones for extended periods without resting their eyes, which can lead to this condition.
Symptoms of eyelid muscle weakness
Currently, eyelid muscle weakness is commonly found in teenagers and working-age adults due to their lifestyle habits. These groups tend to use their eyes extensively for work, gaming, or using computers and smartphones for long periods without resting their eyes. This causes the eyelid muscles to stretch and weaken, leading to eyelid muscle weakness. So today, let’s talk about the symptoms of eyelid muscle weakness and check them together.
- Droopy eyelids
This occurs from congenital eyelid muscle weakness due to underdeveloped eyelid muscles, causing the eyes to appear droopy all the time. The drooping eyelids cover the eyes, affecting vision and daily life. - Difficulty opening the eyes
Caused by loss of eyelid muscle strength, making it hard to open the eyes fully. This results in sleepy-looking, droopy eyes that appear unattractive and can negatively affect appearance. - Eyebrow lifting problem
Because the drooping eyelids cover the cornea and reduce vision, people tend to raise their eyebrows and forehead to see more clearly. This can cause wrinkles on the forehead. - Frequent eye rubbing
Rubbing the eyes can cause increased sagging due to stretched eyelid muscles. This may lead to multiple eyelid folds or creases, making the eyes look droopier than usual.
What is MG (Myasthenia Gravis)?
Eyelid muscle weakness, also known as MG (Myasthenia Gravis), is a condition caused by the immune system attacking the connection between nerve endings and muscles (neuromuscular junction). This is known as an autoimmune disorder, where the immune system functions abnormally. The causes of MG or Myasthenia Gravis include:
- Abnormalities in the immune system
- Enlarged or abnormal thymus gland
- Genetic factors
Symptoms of MG (Myasthenia Gravis)
The most common symptom, found in 70–85% of early-stage cases, is drooping eyelids (extraocular muscle weakness) and double vision. However, when one eye is closed, the double vision usually disappears. In some patients, there may also be muscle weakness affecting speech, swallowing, the mouth, throat, and limbs. In severe cases, respiratory muscle weakness (myasthenic crisis) can lead to respiratory failure, which may be life-threatening.
Diagnosis and treatment methods for MG affecting the eyelid muscles
Since MG (Myasthenia Gravis) presents with symptoms and characteristics similar to other muscle weakness disorders, a thorough medical history is essential. In cases where symptoms are mild and the patient suspects they may have MG, there are two basic self-tests that can help identify the condition:
- Ice Test
This test uses cold to evaluate symptoms. Place an ice pack or wrapped ice over the eyelid while keeping the eyes closed for about 2 minutes. After removing the ice, measure the eyelid opening. If the eyelid opens 2 millimeters or more wider than before the test, it is considered a positive result and may indicate MG. You should observe the change within 30 seconds after removing the ice, as the effect wears off quickly. If the result is positive, it’s recommended to visit a hospital for an official diagnosis and appropriate treatment. - Sleep Test
This test involves resting for 45–60 minutes to compare eyelid condition before and after sleep. It can be done as follows:- If you have droopy eyelids or difficulty opening your eyes, take a selfie right after waking up.
- Go about your daily routine as usual.
- Take another selfie in the afternoon.
- Compare the two images to see if the eyelids appear more droopy later in the day, which could indicate MG.
When comparing the two photos, observe whether your eyes appear more alert and open in the morning selfie, but look smaller, less open, or show signs of drooping eyelids in the afternoon photo. If such differences are noticeable—especially increased drooping later in the day—it may indicate symptoms of MG.
- Testing for MG at the hospital
To diagnose MG (myasthenia gravis) at the hospital, doctors will take a detailed medical history and perform physical examinations, such as:- Pupil dilation examination and muscle contraction tests
- The Prostigmin test involves injecting Prostigmin into a muscle and evaluating muscle weakness at 15, 20, 25, and 30 minutes after the injection.
- Nerve and muscle electrical testing
This involves applying a safe level of electrical current to stimulate the suspected nerve pathways. A monitoring device records the muscle responses, displaying the results as graphs on a screen. This helps diagnose neurological and muscular disorders, such as MG.
Treatment of MG (myasthenia gravis)
MG-related eyelid muscle weakness should not be treated with eyelid muscle surgery. When this condition is suspected, further tests are done for diagnosis, and treatment is through medication—not surgery. As the patient’s MG symptoms improve, abnormal eyelid elevation may occur. Medication treatment is divided into three types as follows:
- Cholinesterase inhibitors
These help increase neurotransmitter function. They are generally safe but may cause side effects like stomach pain and muscle twitching. - Steroids
Used when symptoms other than drooping eyelids are present. Patients should not stop steroids on their own and must follow the doctor’s instructions carefully to avoid side effects such as hormonal imbalances. - Immunosuppressants
These medications have the most side effects, including potential liver damage and bone marrow suppression.
However, it is essential to take the medication exactly as prescribed by the doctor to ensure effective treatment and the patient’s safety.
Eyelid muscle weakness vs. MG: What’s the difference?
Eyelid muscle weakness
- Symptoms
A condition where the eyelids do not fully open. The upper eyelid droops more than usual, covering part of the iris, making the eyes look tired and causing difficulty in opening the eyes fully. - Causes
- Congenital eyelid muscle weakness
- Age-related eyelid muscle weakness, such as sagging of the eyelid muscles
- Eyelid muscle weakness caused by daily habits like frequent eye rubbing, prolonged use of contact lenses, or complications from double eyelid surgery
- Treatment
Can be corrected with double eyelid surgery.
MG or Myasthenia Gravis Disease
- Symptoms
There is fluctuating ptosis, meaning it comes and goes. Symptoms are usually milder in the morning but worsen by the afternoon and improve after rest. - Causes
Immune system abnormalities, thymus gland abnormalities, genetics. - Treatment
Not suitable for surgical treatment; managed with medication.
If the weak eye muscles are not treated, is it dangerous?
Many people may think that “when having ptosis (weak eyelid muscle), there is no need to rush treatment because it is not dangerous and does not affect daily life.” However, this is a misunderstanding. Ptosis can have more serious impacts than expected. Besides causing droopy eyelids, sleepy-looking eyes, and uneven eyelids, it also reduces visual efficiency. For some professions, this condition can be an obstacle to work performance.
It is clearly noticeable that this condition directly affects vision, right? Vision is a crucial part of learning and understanding the world around us. If our eyes lose their visual efficiency, it could lead to various problems in the future, whether in work, traveling, reading, or even leisure activities. Additionally, it can cause a loss of confidence in social interactions as well.
The difference between ptosis correction and double eyelid surgery is as follows:
Ptosis correction surgery involves operating deeply on the muscle layer to strengthen the eyelid muscles. It addresses issues like droopy eyelids, tired-looking eyes, and constantly sleepy appearance, helping the eyes open better. Because this surgery is more delicate and complex than double eyelid surgery, it takes considerably more time to perform.
Double eyelid surgery involves creating a new eyelid crease to address issues such as small eyes, droopy eyelids, fat deposits on the eyelids, hidden creases, or monolids. This surgery makes the eyelid crease more defined, making the eyes look bigger and brighter. There are two main techniques for this surgery: the long incision technique and the short incision technique.
Common side effects after eyelid surgery include
Currently, double eyelid surgery is very popular. The trend nowadays favors big, bright eyes that look like they’re smiling all the time, adding charm to the face. This has led many women to choose double eyelid surgery. However, it’s important to remember that all types of surgery carry risks, including possible side effects after the operation if self-care isn’t done properly. Patients should strictly follow their doctor’s instructions. So today, I’ll share the common side effects after surgery that often occur—but don’t worry, these symptoms usually improve gradually over time.
Short-term side effects
These are symptoms that occur within 7–14 days after surgery.
- Bruising
This is a common symptom after surgery caused by blood leaking under the skin, resulting in a greenish bruise. It often occurs in people who bruise easily. The best treatment is to apply cold compresses initially and then warm compresses later to reduce bruising. - Wound infection
After surgery, it is important to keep the wound clean and well cared for. Poor wound care, wet wounds, or unclean washing may cause infection. - Wound separation
This can be caused by suturing technique, premature suture loosening, or infection. If you notice the wound edges separating, it is recommended to see a doctor promptly for treatment, as leaving it untreated may cause an unattractive scar and an uneven eyelid. - Incomplete eye closure
Some patients may have difficulty closing their eyes fully due to swelling of the eyelid wound and anesthesia effects. Don’t worry—this swelling will subside and heal on its own. If there is eye irritation, using artificial tears during the day can help relieve discomfort temporarily.
Long-term side effects
- Eyelid crease detachment
Caused by eye irritation leading to rubbing, or if the surgeon uses an inexperienced technique. If eyelid crease detachment occurs, consult a doctor for corrective surgery within 14 days. - Uneven swelling of double eyelids
Normally, swelling subsides fully after about 3 months. Uneven eyelids may be caused by excessive removal of eyelid fat by the surgeon, leading to deep eye sockets. Some cases may also have weak eyelid muscles. - Eyelid crease too large
Mainly caused by the surgeon stitching the crease too high or excessive removal of eyelid fat during surgery. - Visible scars on double eyelids
Normally, swelling reduces and the skin becomes smooth within 3-6 months. Poor wound care may cause keloids, resulting in uneven and unsightly scars.
Surgical outcomes for correcting ptosis (drooping eyelid) due to muscle weakness
As we all know, ptosis is a condition where the eyelid droops or sags lower than normal, which can affect one or both eyes. If left untreated, it can significantly impact daily life. These symptoms can be corrected through surgery to repair the eyelid muscles.
The postoperative results after eyelid muscle repair surgery are as follows:
- The eyelids do not overlap into multiple folds and there are no wrinkles on the eyelids.
- Helps to open both eyes better, resulting in a proper amount of visible iris—not too wide—making the eyes look softer and symmetrical.
- Allows normal eyelid opening, reducing the chance of forehead wrinkles caused by raising or furrowing the eyebrows.
- Can be combined with double eyelid surgery since the incision for muscle repair and double eyelid surgery is the same. This not only enhances the eyelid crease definition but also effectively corrects droopy eyelids, tired-looking eyes, and dull eyes.
For anyone who wants to undergo ptosis (droopy eyelid) muscle repair surgery, it is important to thoroughly research the information and consult with a doctor every time before receiving treatment. This ensures safety, addresses the problem accurately, and achieves good, personalized results.
