MEDICAL CONDITIONS WITH EYE IMPACT

 

There are more than 425 diseases causing droopy, sagging eyelids or ptosis.

NERVE AND MUSCLE DYSFUNCTION

Lily Leading Instant Eye Lift is not designed to treat nerve or muscle dysfunction, however may improve the related ptosis. Lily holds a portion of the skin of the upper eyelid in place, preventing it from sagging down toward the lashes. Lily adds support at the top of the lid, where the lid meets the brow bone. The strip is placed over the fold line on the eyelid, usually found higher up on the lid. If the droop in your lid is caused by the inability of the muscle to hold the lid up, you may not benefit from using Lily. However, if the droop is being caused by the weight of the sagging skin pushing the lid down, Lily most likely will work well. The results vary form person to person, depending on the nature, cause and severity of the ptosis and the way Lily is applied. Lily does not affect the underlying disease. For treatment of the illness or underlying cause of ptosis, we advise you to consult a doctor.

INFECTIONS

In case of an infection or inflammation of the eye(s) or upper eyelid(s), you should not use eye make-up or Lily. 

DERMATOCHALASIS

Redundant and lax eyelid skin and muscle is known as dermatochalasis.

Dermatochalasis is a common finding seen in elderly persons and occasionally in young adults. Natural aging: gravity, loss of elastic tissue in the skin, and weakening of the connective tissues of the eyelid frequently contribute to this lax and redundant eyelid tissue. These findings are more common in the upper eyelids but can be seen in the lower eyelids as well.

In some cases, severe stress or trauma can accelerate the aging process, resulting in dermatochalasis at an earlier than normal age. Some systemic diseases also may predispose patients to develop dermatochalasis. These include thyroid eye disease, renal failure, trauma, cutis laxa, Ehlers-Danlos syndrome, amyloidosis, hereditary angioneurotic edema, and xanthelasma. Genetic factors may play a role in some patients.

Dermatochalasis can be a functional and cosmetic problem for the patients. When functional, dermatochalasis frequently obstructs the superior visual field. In addition, patients may note ocular irritation, entropion of the upper eyelid, ectropion of the lower eyelid, blepharitis, and dermatitis. When cosmetic, patients note a fullness or heaviness of the upper eyelids, "bags" in the lower eyelids, and wrinkles in the lower eyelids and the lateral canthus.

Dermatochalasis can be separated into early and late phases. The early phase is divided further into hypertrophic and atrophic forms. The cause is probably a localized form of angioedema. Sequelae include conjunctival edema and injection, entropion, ectropion, steatoblepharon, ptosis, and excessively thin skin.

Treatment

In general, the treatment of dermatochalasis is surgical. The following medical treatments may be appropriate:

  • Dermatochalasis patients with blepharitis may benefit from lid hygiene and topical antibiotics.
  • Dermatochalasis patients with dermatitis may benefit from topical steroid ointment.
  • Dermatochalasis patients with dry eyes should be treated with the appropriate topical lubricant. In addition, placement of temporary collagen punctal plugs, permanent punctal plugs, or punctal cautery may be considered in patients with a history of dry eye or a physical examination consistent with dry eye. These measures may be used preoperatively to further evaluate the patient prior to embarking upon surgery.

Not all patients are good candidates for surgical treatment. In this case Lily Leading Instant Eye Lift might offer an alternative solution for ptosis caused by dermatochalasis. When the skin of the upper eyelid is very thin and large, Lily will give relief and cosmetic results may vary.

BLEPHAROCHALASIS (inflammation - stretching / atrophy of eyelid)

Blepharochalasis syndrome is separate and distinct from dermatochalasis and is a rare disorder that typically affects the upper eyelids. Blepharochalasis syndrome is characterized by intermittent eyelid edema, which frequently recurs. This results in relaxation of the eyelid tissue and resultant atrophy. In approximately 50% of patients, it is unilateral. Blepharochalasis rarely can be associated with agenesis of the kidney, vertebral abnormalities, and congenital heart defects. 

INFLAMMATIONS AND INFECTIONS 

A stye (hordeolum) is an inflammation of a sweat gland or sebaceous gland at the edge or under the eyelid. The inflammation occurs suddenly. The output of a sweat or sebaceous gland can become obstructed. Bacteria (usually staphylococcus aureus) can reach the gland. These bacteria multiply and cause inflammation. There is a (red) sometimes painful swelling on the inside or outside of the eyelid, close to the edge of the eyelid. Often this is a pimple with a white head. Once the pimple “breaks” through, the pain is over.

The cause is often a contagious bacteria. Try to prevent self-contamination or infecting others by employing hygienic measures (see blepharitis).

Chalazion means small lump and appears as a red, non-tender lump on the eyelid. It is a non-infectious inflammation of the eyelid soft tissue, due to fats squeezed from the obstructed oil glands.  Treatment usually is not necessary. Warm compresses soften thick fats thus helping in drainage. If a chalazion is big or it does not clear in several weeks, an injection of steroids or a surgical incision may be necessary.

Blepharitis is an inflammation of the eyelid, appearing as reddened, swollen, itchy, and burning eyelid margin. Scaling, pustules, crusts or ulcers may appear. the severity and time course of which can vary. Onset can be acute, resolving without treatment within 2–4 weeks (this can be greatly reduced with lid hygiene), but more generally is a long standing inflammation varying in severity. Acute blepharitis may be caused by herpes simplex or herpes zoster (varicella) virus, the bacteria stapylococcus aureus, or allergy. Chronic blepharitis may be associated with seborrheic dermatitis, acne rosacea, lice or allergies.

Treatment

Viral infections are treated with antiviral drugs by mouth, and bacterial infections by antibacterial ointments. In marked swelling or allergy, topical corticosteroids may be used. Try to prevent self-contamination or infecting others by employing hygienic measures.

A typical lid margin hygiene routine consists of four steps:

  1. Softening of lid margin debris and oils: Apply a warm wet compress to the lids - such as a washcloth with hot water - for about two minutes. New, dry, warm compress masks can be conveniently warmed in a micro-wave oven and maintain a comfortable 40C temperature for 10 minutes while the waxy oils blocking the glands are cleared. The humidity created also helps to reduce the evaporation of natural tears which are important in soothing the cornea.
  2. Mechanical removal of lid margin debris: At the end of a shower routine, wash your face with a wash cloth. Use facial soap or non-burning baby shampoo (make sure to dilute the soap solution 1/10 with water first). Gently and repeatedly rub along the lid margins while eyes are closed. Too much soap or shampoo may remove the essential oily layer of the eyes' own tear film and create further problems with dry eye discomfort.
  3. Antibiotic reduction of lid margin bacteria (at the discretion of a physician): After lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed. Use prior to bed time as opposed to in the morning to avoid blurry vision.
  4. Avoid the use of eye make-up until symptoms subside.

 

DIABETES MELLITUS

Diabetes Mellitus can cause paraylsis of the nerve that controls the upper eye muscle with ptosis / drooping eyelids as a result. See also oculomotor nerve palsy.

HEADACHES AND MIGRAINES

Ophthalmoplegic migraine begins with a headache felt in the eye and is accompanied by vomiting. As the headache progresses, the eyelid droops (ptosis) and nerves responsible for eye movement become paralyzed. Ptosis may persist for days or weeks.

Ptosis is most often seen discussed as a symptom of cluster headaches. Cluster headaches are often said to be the most painful of all headaches with attacks of severe pain lasting 15-180 minutes and occurring from once every other day up to eight times in one day. Cluster headaches are diagnosed as "episodic" when the attacks occur in periods lasting 7 days to 1 year separated by pain-free periods lasting 1 month or longer. In "chronic" cluster headaches, attacks occur for more than 1 year without remission or with remissions lasting less than 1 month.

HORNER’S SYNDROME

Also called syndrome of Claude Bernard, is a neurological syndrome caused by loss of sympathetic innervation of usually one eye, with the following symptoms:

  • small pupil
  • ptosis by relaxation of the muscle of Müller

In addition, the perspiration from the face can be distorted.

Treatment

First consult your doctor. It is important – if possible – to figure out the cause and get treatment. If the cause cannot be found, there is still a small chance that the ptosis is only temporary. For Horner's syndrome itself there is no treatment available. However, symptoms, such as, the drooping eyelids can be treated.

CARNITINE DEFICIENCY

Carnitine is a naturally occurring amino acid that is produced in the kidneys, brain and liver.  It transfers long-chain fatty acids into mitochondria for beta-oxidation, helps energy centers in the muscles and helps  maintain the health of nerves. 

Carnitine deficiency is an autosomal recessive genetic disease, but can also be caused by other diseases (secondary). There is a big variety causes and symptoms in severity and nature. There is a form where the shortage of carnitine occurs only in the muscles (myopathic form) and a form where it also occurs in other organs (systemic form). The myopathic form is very rare. The first symptoms of muscle weakness can occur in early childhood. It is a general weakness involving the proximal muscles (near the trunk) more affected than distal muscles (further away from the trunk). The facial muscles may be affected. Central to the treatment of all forms is the administration of carnitine to overcome the deficit and its consequences.

CPEO: CHRONIC PROGRESSIVE EXTERNAL OPHTHALMOPLEGIA

Chronic progressive external ophthalmoplegia (CPEO) is a condition where all the external eye muscles gradually become paralyzed. The cause is in the DNA. CPEO is a slowly progressing and rare disease that may affect those of all ages, but typically manifests in the young adult years. The first presenting symptom of ptosis is often unnoticed by the patient until the lids droop to the point of producing a visual field defect. Often, patients will tilt the head backwards to adjust for the ptosis of the lids. In addition, as the ptosis becomes more severe, the patients will use the frontalis (forehead) muscle to help elevate the lids. The ptosis is typically bilateral, but it may be unilateral for a period of months to years before the other lid becomes involved.

Symptoms

First and most striking features are: the drooping upper eyelids of both eyes (with obstructed vision).

Other features include:

Impaired eye movements, making it increasingly difficult and necessary to move the head to see and follow. This progresses very slowly.

The hard squint of the eyes is difficult and possibly also other muscles of the face, neck, shoulders and limbs can become weaker.

There are very serious forms of CPEO:  Kearns Sayre Syndrome / KSS  & ocular pharyngeal dystrophy / OPMD / ocular pharyngeal muscular dystrophy.

Treatment

There is no treatment that can stop the progress of CPEO. There are a number of small studies that have indicated that administration of coenzyme Q10 may slow the process. However, some symptoms caused by CPEO be treated, such as ptosis.

DYSTROPHIA MYOTONICA

Dystrophia myotonica is a rare inherited disorder that has various types and often presents itself with weakness of the muscles most distant from the trunk and in the face with ptosis or drooping eyelids as a result.  Cataract may be the first symptom of DM, although this is rare. The age at which the disease surfaces is different for everyone. There is no treatment that can cure or slow down the disease. However, symptomes like ptosis / drooping eyelids can be dealt with.

FAS : FETAL ALCOHOL SYNDROME

FAS or Fetal Alcohol Syndrome is a congenital disorder caused by high alcohol intake during pregnancy of the mother in the fetal stage. At birth, this leads to miscarriages in 70 percent of all cases.  Most often children exhibit one or two of the symptoms after birth:

  • Light to heavy underweight
  • Specific facial features
  • Flat shaped, short upturned nose
  • Opening of the eyelids to the small side
  • Receding jaw
  • Damage or injury to the central nervous system
  • Non-functioning or damaged kidneys, heart and / or intestines
  • Severe form of hyperactivity

 

KSS: KEARNS SAYRE SYNDROME

Kearns Sayre syndrome (KSS) is a rare (approximately 1:600.000) metabolic disease.  KSS belongs in the groups of mitochondrial and muscular diseases.

Cause

The mitochondrion is the 'power' of the cell. In the mitochondrion, substances of sugar and fat are transformed into in to energy with help of oxygen. This energy ensures proper functioning of organs and helps the muscles to move. When you suffer from Kearns Sayre syndrome the mitochondrion does not function proporly. The cause of the inproper performance is an error in the genetic material, called DNA.

Kearns Sayre syndrome is usually transmitted by the mother, but the disease can also occur spontaneously.

Symptoms

The disease usually begins before puberty. The most common symptoms are having difficultiy or not be able to move the eyes and droopy eyelids. Sometimes the facial muscles weaken and swallowing and speech problems occur. Approximately 50% of all patients have also problems with other muscles such as neck and shoulder girdle and pelvic girdle muscles. In addition patient can have cardiac arrhythmias. If the disease begins at a young age, growth often will fall behind and mental retardation may occur. The symptoms worsen during the course of the years. The droop of the eyelids can become so severe that this obstructs the vision.

Diagnosis

In order to diagnose this disease, several examinations have to be conducted. The amount of lactic acid (lactate) in the blood is measured and the urine examined. Often, a piece of muscle (a muscle biopsy)  is taken to investigate abnormalities in the muscle fibers. In addition, analysis of the DNA is a possibility. KSS can affect life expectancy. This depends on the severity and nature of the phenomena. To give a clear projection is often not possible.

Treatment

For Kearns Sayre syndrome is currently no cure. However, the symptoms may be treated. For cardiac arrhythmias for example a pacemaker may be placed. Alcohol and smoking can affect the progression of the disease.

MARCUS GUNN / JAW WINKING

Jaw-Winking: is a congenital neurological condition where one eye is hanging down, but opens when the mouth is opened or moved from left to right. This is known as Gunn's syndrome or Marcus Gunn syndrome and is not common: 2-13% of congenital ptosis. The cause is not yet fully known.

Treatment

After you have consulted a doctor, symptoms may be treated with botulinum toxin combined with a correction of the eyelid.

MYASTHENIA GRAVIS

Myasthenia gravis can cause ptosis or drooping eyelid. Almost all patients with MG have symptoms of ptosis (70%) and almost everyone with MG develops problems (90%). These symptoms are caused because the muscles react differently to nerve impulses, causing the muscles to weaken. This disease also affects muscles elswhere in the body. 

MYOTONIC DYSTROPHY / CURSHMANN STEINERT DISEASE

Myotonic dystrophy (DM type 1), also dystrophia myotonica, or Curshmann Steinert disease or Steinert disease, is a rare hereditary disease 3-15 per 100,000 in Europe. Typical symptoms are delayed relaxation of strained muscles (myotonia) and a slowly progressive muscle weakness (dystrophy) in face and jaw muscles, the drooping of the eyelids (ptosis), weakness of the neck muscles, hands and lower legs. Besides the muscles, the organs can also cause symptoms. Moreover, listlessness, an increased need for sleep can develop, and children may have learning and behavioral problems. DM1 has a severe congenital form and a milder childhood-onset form.

Myotonic dystrophy type 2 (DM2), also called proximal myotonic myopathy (PROMM), is even more rare than DM1 and generally manifests with milder signs and symptoms. Myotonic dystrophy can occur in patients of any age.

Treatment

There is currently no cure for or treatment specific to myotonic dystrophy. Therefore, the focus is on managing the complications of the disease, particularly those relating to the cardiopulmonary system as these account for 70% of deaths due to DM1.

NF1: NEUROFIBROMATISIS TYPE 1 aka VON RECKLINGHAUSEN’S DISEASE

Neurofibromatosis type 1 (abbreviated NF1) was formerly also called  Von Recklinghausen's disease and is a genetic and partly heriditary disorder. NF1 is a rare disease. Only 1:3000 people are born with NF1. Usually  symptoms and complications occur in childhood and adolescence.

The most common symptoms of NF1 are:

  • Cafe-au-lait spots on the skin
  • freckles in armpit and groin
  • specks in iris of the eyes
  • neurofibromas in the sheath of the nerves, or just under the skin, sometimes on the optic nerve. The non-cancerous lumps can cause pain, deformity and loss of activity of the nerves.
  • Bone deviations
  • Motor, learning, speech and behavioral problems

 

OCULAR MYOPATHY

Ocular myopathy  Ocular (eye), myopathy (muscle disease) is a disease of the eye muscles: impaired function of the levator muscle that lifts the eye. The disease usually begins between the twentieth and fortieth year. Often the first symptom a drooping upper eyelid . It becomes slowly more difficult to move the eyes.  Ultimately more muscles in the face get paralyzed and  sometimes in neck, upper torso and upper arms. Ocular myopathy is sometimes hereditary. There is no cure, but symptoms like ptosis be treated.

OCULOMOTOR NERVE PALSY / OCULOMOTOR NEUROPATHY

Oculomotor nerve palsy also called oculomotor neuropathy is a disorder of the eye due to damage of the 3rd cranial nerve involved in controlling the muscles that move the eye, pupil and the muscle of the upper eyelid (levator palpebrae superioris). This often leads to strabismus or double vision (diplopia) and in almost all cases ptosis. Oculomotor palsy may be caused by vascular diseases such as diabetes, heart disease, atherosclerosis, aneurysm and posterior communicating artery, tumors, inflammations and infections, trauma, demyelinating disease (such as multiple sclerosis), autoimmune diseases, as complication of surgery or cavernous sinus thrombosis.

treatment

There is no direct medical treatment that alters the course of the disease and is directed at alleviating symptoms. The condition is expected to resolve spontaneously within a few weeks.

OCULOPHARYNGEALE DYSTROPHY / OPMD / OCULAR PHARYNGEAL MUSCULAR DYSTROPHY

Oculopharyngeale dystrophy or OPMD = Ocular pharyngeal muscular dystrophy is a disease of the eye (oculo) and throat (pharyngeal). Dystrophy means that muscles slowly getting smaller and weaker. The disease is rare. The symptoms usually occur between the fortieth and sixtieth year, and occur for the first time in the eyelids and throat muscles.  Because the muscles in the eyelids are affected, the upper eyelids are haning (ptosis). Progression can cause the eyelids to block the pupil and obstruct vision. The natural reaction is to raise the eyebrows and keep the head back. Oculopharyngeale dystrophy is usually inherited. There is no treatment for OPMD to cure the disease or slow down the pogression. However, the symptoms can be treated, like ptosis.

STURGE WEBER SYNDROME

Sturge-Weber is a congenital disorder characterized mainly by a wine stain on the face (round and / or above the eye). Sturge-Weber syndrome has a number of related clinical symptoms and is not actually a disease. The cause (developped during pregnancy) is still unknown. The number of children born with the syndrome is very low: + 1: 230,000.  The age of patients varies from 0 - 80 years.

DRUG  USE

Some medication / drugs can cause the eyelid(s) to droop, also called ptosis:

  • Acular Eye drops
  • AK-Dex
  • AK-Pred
  • Alrex
  • Botox
  • Botulinum Toxin
  • Decadron
  • Dysport
  • Econopred
  • Econopred Plus
  • Etabonate
  • Flarex
  • Flecainide
  • Flecatab
  • Fluor-Op
  • Fluorometholone
  • FML
  • FML Forte
  • FML-S
  • Framycetin
  • Herion
  • HMS
  • Hydrocodone
  • Lotemax
  • Lumigan
  • Morphine and others in high doses
  • Maxidex
  • Opiates
  • Otodex
  • Oxycodone
  • Pred Forte
  • Pred Mild
  • Prednisolone
  • Rescula
  • Rimexolone
  • Sofra-Tulle
  • Tambocor
  • Tobispray
  • Travatan
  • Vexol
  • Xalatan

 

BPES: BLEPHAROPHIMOSIS

Blepharophimosis Ptosis Epicanthus inversus Syndrome is a congenital and rare syndrome, where it may be necessary at a very young age to surgically correct the ptosis for the development of good eye sight and avoid a lazy eye and strabismus.

Blepharophimosis, ptosis, and epicanthus inversus syndrome, either with premature ovarian failure (BPES type I) or without (BPES type II), is caused by mutations in the FOXL2 gene.

BPES eyelid abnormalities are:

  1. Blepharophimosis: Blepharo means eyelids and 'Phimosis' means closed opening. Blepharophimosis is a strong narrowing of the eyelids (narrowing between the inner and outer corner). In adults, the width of the lid 25 to 30 mm. In adults with BPES this distance is 20-22 mm.
  2. Ptosis: both eyelids droop (symmetric) and can hardly be lifted;
  3. Epicanthus inversus: A condition in which a fold of skin that stretches from the lower eyelid upward and toward the nose partially covers the inner canthus. It is often associated with ptosis;
  4. Telecanthus: abnormally increased distance between the medial canthi of the eyelids. There is usually no visible sclera (white of the eye) between the corner and the iris.

Given the severity of the ptosis, the impact it may have on the development of vision and the eyes and considering the young age of patients with BPES, it is recommended to (only) rely on the advice given by a physician.

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