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Ptosis of eye. Dryness and infection. On lubricating drops. Why is the eye twitching getting worse?

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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 accidently 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 initial exams on my eye and noted the ptosis, but said it was likely due to the infection and due to 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 blink my eye hard (like squinting shut), 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.
Other things I notice: When I wake up in the morning and up to a few hours after waking up, my eyelid seems fine and doesn’t twitch or get stuck. 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. Also I noticed the twitching/eye getting stuck subsides 2 to 3 hours before bed, but slight ptosis is back (I’m usually laying down watching tv at that time of night). Now noticing as I write this, I have not been lying down much at all, and the twitching/eye getting stuck symptoms are gone, but slight ptosis is back.
Question: What might be causing this?
Posted Wed, 11 Apr 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 57 minutes later

Thanks for the query. I appreciate the way you presented your query. You have been able to give me a detailed account of your problem.

To answer your query about what might be causing this.

You mention now that ptosis is almost completely gone away, but you have another symptoms – twitching of eyelid for a while when you blink.

1. Drooping eyelid or Ptosis is caused by damage / trauma to the muscle which raises the eyelid, damage to the superior cervical sympathetic ganglion or damage to the nerve (3rd cranial nerve - oculomotor nerve) which controls this muscle. Eye infections and dry eyes rarely cause ptosis. Sometimes the drooping may be worse after being awake longer, when the individual's muscles are tired. Stress and exertion are other factors that worsen symptoms.

2. It could be a sign of myasthenia gravis, brain stem problem or compression of oculomotor nerve.

3. In the back ground of ptosis, lid retraction and twitching can be seen in myasthenia gravis.

After having gone through your complete details, I personally feel you need to consult Neurologist (if you haven’t previously consulted yet) for clinical examination and consultation for the cause and treatment.

Let me know if I have missed out any other concern in your question.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.


Dr Shiva Kumar R
Neurologist & Epileptologist
Above answer was peer-reviewed by
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