An Eye for an Eye!

This beautiful lady came to us with complaints of Right droopy eyelid or Right Upper eyelid ptosis. She was investigated extensively for Myasthenia Gravis by a neurologist elsewhere with multiple tests- all of which ruled out myasthenia. She came to us for a second opinion.

On clinical examination, the cause of the ptosis was quite clear- Aponeurotic- that is the muscle lifting the right upper eyelid was stretched and was not as efficient as the opposite eyelid.

So right eyelid ptosis correction surgery was performed and the Levator Palpebral Superioris (LPS) muscle was tightened to correct the right upper eyelid ptosis.

However, her left upper eyelid began to droop after correction of the right upper lid ptosis. This is an uncommon possibility post unilateral ptosis correction explained by Hering’s Law. With experience of operating on many droopy eyelids over the years, one knows how to predict this phenomenon ahead of surgery. This patient was warned of this possibility before surgery as hering’s response was elicited before it was easier to counsel for ptosis correction of the left upper eyelid.

Hering’s response elicited ahead of first surgery where the left upper eyelid droops on temporary correction of right upper eyelid ptosis using a probe.

Hering’s Law for the eyelids: There is reflexive descent of the contralateral upper eyelid after the ipsilateral surgical correction of unilateral ptosis. Hering’s law is explained by considering the two eyes as paired organs and it follows that the muscles moving it will work in co-ordination. The co-ordination of eyelid opening muscles- LPS is controlled by a common central caudal sub-nucleus of the oculomotor complex which innervates both LPS. So second surgery on the left upper eyelid was performed which ensured symmetry of the eyelid position. 

Surgical stages- At presentation (top), after 1st Surgery (middle) and after 2nd surgery (bottom)

This is the before and after photo collage of the final correction with a very happy patient.

Patient at presentation with right upper lid ptosis (above) and (below) after both serial ptosis correction surgeries to both upper eyelids

If you or someone you know are suffering from this easily correctable condition, consult your nearest Oculoplastic Surgeon.

⏲Surgery time: 30-45 mins
💉Anaesthesia: Done under Local
🗓️Downtime: 3-4 weeks
📈Duration of effect: Long term
📠 Phone: +91 80 2502 3257
🖥️ Website:

©All patient photos are being used with the express consent of the patient. These cannot be shared or reproduced elsewhere.

Published by Dr. Raghuraj Hegde

Free thinker| Poet| Writer| Traveller| Doctor| Ophthalmic Plastic Surgeon

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