Myasthenia gravis (MG) is a condition where the
communication between muscles and nerves is damaged. There's no cure for this
condition, so if you've just been diagnosed with it, you'll need to look at
different treatment options to manage your symptoms.
Because myasthenia gravis causes muscle weakness, one issue
people with the disorder experience is drooping brows and eyelids. Read on to
learn more about eye problems and how surgical options like blepharoplasty can
help.
How Are Drooping Eyelids Usually Treated in MG?
Known as blepharoptosis, eyelid drooping is not only a
cosmetic issue but a functional one. Some people with myasthenia gravis have
such weak muscles around their eyes and eyelids that the eyelid itself droops
enough to obscure the pupil's vision.
To treat the problem, some doctors may recommend
cholinesterase inhibitors. These types of medications block the breakdown of
acetylcholine. Acetylcholine is a neurotransmitter that helps to contract
smooth muscles.
Again, there is no cure for myasthenia gravis, but these
medications can certainly help improve muscle strength and contraction. The
downside of cholinesterase inhibitors is that some people can experience side
effects, such as:
- Nausea
- Sweating
- Upset
stomach
- Excessive
saliva
- Diarrhea
Some people may simply not respond to the medications and
still suffer from drooping eyelids. If conservative treatment doesn't work,
your doctor may recommend that you see an ophthalmologist to get a
blepharoplasty.
How Can Surgery Help?
A blepharoplasty is a procedure where a doctor repositions
drooping tissue on the eyelids. Some doctors take the blepharoplasty a step
further with a ptosis surgery. During a ptosis surgery, your doctor won't only
correct the eyelids, but they will correct droopiness around the eye and
reinforce the eyebrow's levator muscle.
One study
found that surgery could be a useful therapy to improve eyelid height in
patients with myasthenia gravis - especially if other management therapies
weren't working.
Another study
- found
in the Transactions of the American Ophthalmological Society
journal -
also found that surgery could improve eyelid height and be a good option if
other treatments had failed.
What Is Surgery Like?
Surgery will only take a few hours; your doctor can use oral
sedation or IV sedation. While blepharoplasty is usually an outpatient
procedure, you will still need someone to drive you home while you recover from
anesthesia.
Some people may be worried about scars during the procedure,
but your doctor will make incisions along the natural creases of the upper and
lower eyelids. While some doctors may use a scalpel to make adjustments, there
are also options to remove excess tissue with a CO2 laser.
When adjustments are made, your doctor will stitch up the
incisions. Stiches will usually dissolvable, so you won't have to have them
removed once the procedure is done.
What Is Recovery Like?
You will likely experience some tenderness, bruising, and
swelling post-op. Your doctor may recommend over-the-counter medications so you
can manage the pain. Ice packs can also help with pain management.
One problem participants in the previous studies faced
post-operatively was diplopia, also known as double vision. If you wear an eye
patch, you can reduce the eye strain of double vision and help strengthen
vision in your non-dominant eye. Your doctor can go over how to wear an eye
patch and how often.
Another side effect that was seen in the previously
mentioned studies was exposure keratopathy. Exposure keratopathy is damage to
the cornea due to dryness - often because the eyelid can't close completely.
You should reach out to your doctor if you are having
trouble closing your eyelid completely. It will be normal to have some dryness
in your eyes afterwards, so your doctor may recommend eye drops or artificial
tears.
Reach out to us at Calvert
Ophthalmology Center
for more information on eyelid surgery.
