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Experiencing slight ptosis. Feeling dryness, twitching and pressure around eye. What is causing this?

Nov 2013
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Practicing since : 1994
Answered : 5287 Questions
Forgive me if this information is overwhelming.

In October of last year, I began to experience slight ptosis of the left eye. Initially I disregarded it and thought it was happening because of lack of sleep (I started a new job and now work two jobs combined for 60 hours per week with rotating hours). I never really noticed the ptosis and actually forgot I even had it until around Thanksgiving, when I noticed the ptosis was more pronounced (even though it was more pronounced to me, most of my co-workers did not notice it until I pointed it out to them) I had wondered if the ptosis was happening because I accidentally put on old pair eye contacts which were dirty. A slight eye infection had occurred, so I decided to try and let it clear.

A few weeks went by and the Ptosis did not improve, and by now I had rubbed the eye quite a bit from the eye infection. Around mid-December I scheduled myself with an ophthalmologist for an exam. The Doctor did exams on my eye and noted the ptosis, but said it was likely due to the infection and due to severe eye dryness (a condition I’ve had all my life). He gave me some lubricating drops to use four times a day and asked me to return a week later. I began using the drops right away, as prescribed, and actually began to notice an improvement in the ptosis. By the time of my follow-up visit, the ptosis had improved significantly and was hardly noticeable to me and not noticeable at all to anyone else. At the follow up, the ophthalmologist ran more tests on my eyes, checking corneas, eye pressure, for eye tumors, glaucoma, and all tests came out favorably. He said it was likely the infection that was causing it, but it’s obviously clear, and that the eye dryness was making it worse (the ptosis). He said I would be fine, but to just continue to use lubricating drops as I have severe dry eye syndrome. By New Years, the ptosis seemed to be completely gone and I began to use the drops less and less.

By mid-January, it appeared that the ptosis had returned, so I began using the drops again. The ptosis never got as bad as it did the first time, so I just continued to use the drops with some concern. Again the ptosis slowly began to clear again through the first of February. The ptosis had nearly gone away completely, but I noticed a new symptom. Whenever I would squint my eyes, my upper eyelid affected by the ptosis would twitch, I would reopen my eyes and my left upper eye lid would appear stuck for a split second, then twitch and return to normal. If I blinked my eyes the same way again, it would be fine and my eyelid would look normal. A few minutes later I would blink and the upper eyelid would do the same thing, move up slowly, twitch and return to normal with the same process – if I blinked again right after no issues.

In February, I went to the hospital to get checked out. The doctor was sure it was Bell's Palsy (however he did not run any tests). He gave me a prescription Prednosone and an Anti Biotic. However, I did not take them because I could not afford the prescriptions at the time.

The twitching has never fully gone away, although the ptosis went away for the most part - maybe 85 to 90 percent better after April through August. Now a couple of weeks ago, I was under a large amount of stress. I felt pressure around my eye, a lot of dryness, and an increase in twitching. The ptosis has also returned to the level it was at back in February.

Other things I notice: When I wake up in the morning and up to a few hours after waking up, my eyelid is not droopy at all and barely twitches. However, a few hours after waking, it begins to take effect, at first only slightly, then progressively getting worse and worse throughout the day. It also appears worse on days I get less sleep. For example, yesterday I woke up after only 3.5 hours of sleep and the twitching/eye getting stuck seemed at its worse yet. Today, I woke up after 7 hours of sleep and it was not as bad, but still somewhat present. When I use lubricating drops, as soon as I use the drops and for several minutes I have absolutely no twitching.

Question: What might be causing this?
Posted Thu, 18 Oct 2012 in Brain and Spine
Answered by Dr. Sudhir Kumar 23 minutes later
Thank you for contacting Healthcare Magic.
First of all, let me tell you that I enjoyed reading your detailed description. It shows your throroughness with the clinical and medical details.
At present, the most likely reason for your ptosis is ocular myasthenia gravis.
In this condition, ptosis is known to be variable (severity differs at different times). Also, the condition is known to spontaneously remit (without treatment) and relapse.
Stress and fatigue are known to worsen the symptoms.
Also, there is a diurnal variation, and the symptoms are worse in evenings.
Following tests can be done to confirm the diagnosis:
1. Neostigmine test
2. Ice pack test
3. Repetitive nerve stimulation
The first two can be done by neuro-ophthalmologist or neurologist and the third can be done by a neurologist.
In any case, you should schedule an appointment with a neurologist.
Please get back if you have any follow up queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
XXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
Follow-up: Experiencing slight ptosis. Feeling dryness, twitching and pressure around eye. What is causing this? 9 hours later
Thank you for your prompt reply. I will do everything I can to get to a neurologist as soon as possible. Is this the only potential problem that can cause ptosis and twitching in one upper eyelid?
Answered by Dr. Sudhir Kumar 1 hour later
Thank you for getting back.
There are other causes too, but in almost all of them, the symptoms do not change. Ptosis remains the same and in some other cases, symptoms get worse over time.
Best wishes,
Dr Sudhir Kumar MD DM
Above answer was peer-reviewed by
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