Southwest, FL | Sudden Drooping of Upper Lid | Cataract & Refractive Institute of Florida

Dr. Croley: Hello and welcome to Case of the Day. I'm Dr. Croley and today we're going to discuss an interesting case that came in today. We had a person who came in who is probably around age 70 or so, and came in complaining that for the last two weeks that their right upper lid was drooping and they were having trouble seeing. And when we examine this patient, the patient's lid was drooping almost halfway down and covering part of the pupil. So that's what's called ptosis. So ptosis is drooping of the upper lid itself. That's not the skin drooping over, which is called dermatochalasis, but this is called ptosis because the lid itself is drooping down. So the muscle that's pulling the lid up is not working correctly.

Dr. Croley: Also, this person after questioning a little further was also having diplopia or double vision. And so when we examine the muscle movement of the eye, this person could not move the right eye in towards their nose very much, could not elevate the eye up very far or down very far. Still could pull the eye out to the side totally. So when you see something and we see a patient like this where the lid is drooping and those muscles that we just discussed are not working correctly, all those muscles in the lid are supplied by the third cranial nerve. Now, we have 12 cranial nerves in our body that supply different things. Several of those cranial nerves actually supply things to our eye. And so in this case, the third cranial nerve supplies several muscles of the eye and also the muscle that pulls the lid up. Also, it also supplies the pupil muscle going to the pupil as well.

Dr. Croley: So on further examination, this patient also had the eye was bulging forward in properly and that's called proptosis. So this person comes in with a two week history of their eye actually bulging forward, the lid drooping and double vision. And so she has a history of also unfortunately metastatic cancer. And so this probably represents that she's had something maybe metastasized behind her eye that's causing the third nerve palsy and her eye protruding forward. Other things that can cause a third nerve palsy is actually a brain aneurysm. And so an aneurysm that is around the circle of willis, which is right sort of in the middle behind your nose is where it is the common to get aneurysms. And the third nerve that comes out from the brain goes across those blood vessels are, and if there is an aneurysm pressing on that nerve, those people get third node palsies as well.

Dr. Croley: So we immediately have started this woman on a workup to see what's going on, to see what's wrong with her orbit. But she waited two weeks before she came in to have this evaluated. So the sort of the tip of the day is if you start noticing that suddenly your eyelid droops or that you're having double vision or that your eye is sort of bulging forward, or loss of vision, her vision was really pretty good, then you should not wait. You should actually come in to see an eye doctor immediately because some of these things could represent, like I said, an aneurysm that you're at risk that it could rupture. And then we have a life threatening situation. Or in this case, unfortunately, I think we're looking at maybe a cancer that's metastasized behind her eye, but we won't know until the CT scans and brain scans come back to see what those results are. So if you have any questions about third nerve palsies or double vision, you can please contact us through the website. If not, have a great day. May God bless you with healthy eyes and great vision until the next time.