Droopy/Swollen Eyelid - probably not MG

My right eyelid has been droopy for about 3-4 weeks now.  It was a sudden onset, I just woke up with it one morning - although I did have blurry vision come and go for a few  months leading up to this.

I've been to an optometrist who sent me to my doctor who sent me to an opthamologist who is now sending me to a neurologist (and possibly a neuro-opthamologist).   Tests for Mysthenia gravis (all three blood tests) were negative.  Two docs thought the ice pack test was negative, one thought it was inconclusive and may have shown some improvement.  No itchy, no injuries, no clue as to what is provoking this.  My ESR is elevated, but that may be unrelated as I also have an enlarged spleen.  

I don't have any pain in my eye, but I do get some headaches on that side of my head - behind the eye, on my forehead, and back to my eye.  These come and go at random and are very uncomfortable but definitely not debilitating.

If MG is unlikely, why would I need to see a neurologist?  What sort of neurological problems could cause this?  How concerning is this?  As annoying as this is (both in that I look weird and the discomfort associated) I'd like to put off seeing the neuro for a short while (few weeks) because my schedule is a bit hectic at the moment... but I don't want to be putting off something if it is urgent.

Any insight you could share would be very much appreciated.  Thank you so much for sharing your expertise here!

[Michael J Kutryb, MD]

Myasthenia is a small possibility, I suppose but I would be more concerned about some degree of Horner's Syndrome or a partial third nerve palsy. Diagnosis of either would require a skilled analysis of the pupils and ocular movement and review of the MRI scan.  I suppose further testing for myasthenia could be done as well.  Remember that involutional stretching of the levator tendon  is also possible but typically does not come on suddenly. The main thing is that you need an mri and possibly mra and referral to a neurologist and possibly a neuro-ophthalmologist.

[MidwesternMom]

Thank you so much for your helpful response!  I'm now scheduled to see a neurologist in three weeks.  

It may be my imagination... but I swear my right ear is a bit lower too.  My husband noticed this also.  I thought my glasses had just gotten crooked at first.  I imagine this is related to the droopy eye.  My lips are are also uneven when I smile (the right side drooping over my teeth rather than pulling up) but I am pretty sure I've had that for a while...

Thanks again for your time and help!  It's great to get to "talk" to an expert in worrying times!!

[MidwesternMom]

I looked up Horner's Syndrome, and that sounds like a possibility.  My husband was the first to notice this, and I could see it too but thought it was just part of general swelling.  My lower eyelid on the droopy eye is actually raised.  So while my upper lid is drooping, the lower lid sits higher.  It makes my eye look smaller.

Is this specific to Horner's Syndrome, or can it happen in many different scenarios?

It is a relief when things sort of fit together (although I don't know what would cause Horner's Syndrome in my case, unless it is related to suspicions of a pituitary issue that I'm waiting to see an endo for...)


Thanks again!!