Eye Issues: When to Worry About Muscle Weakness

Q: Eye Issues: When to Worry About Muscle Weakness

Hello： If the drooping eyelids have been a pre-existing symptom, and the drooping is not episodic (for example, more pronounced when fatigued or in the late afternoon, and improves after a brief rest with closed eyes), and there are no symptoms such as double vision, difficulty s

Eye problems

Hello Doctor,
On May 3, 2019, I visited a neurologist due to arm pain.
The doctor mentioned that it was caused by work-related issues and long-term poor posture.
However, the doctor advised me to pay attention to my eyes, as I have a noticeable difference in size (my left eye is smaller).
The doctor instructed me that if I see double vision or if my eyelids droop significantly at night, I should get checked for possible myasthenia gravis.

I looked through some photos from around 2011, and I noticed that the difference in my eye size has been apparent for a long time (with the left eye being smaller).
Over the past few days, I have been observing my eyes, and I have not experienced double vision, nor have my eyelids been drooping excessively at night.

Could you please advise me if I might have myasthenia gravis or if it is just eyelid drooping? Do I need to undergo any tests? Thank you!

Fanqie, 40~49 year old female. Ask Date: 2019/05/07

Dr. Hong Weibin reply Neurology

Hello: If the drooping eyelids have been a pre-existing symptom, and the drooping is not episodic (for example, more pronounced when fatigued or in the late afternoon, and improves after a brief rest with closed eyes), and there are no symptoms such as double vision, difficulty swallowing, or speech difficulties, it suggests that you are unlikely to have myasthenia gravis.
It would be advisable to monitor the situation for now.

Reply Date: 2019/05/07

More Info

When it comes to understanding eye issues, particularly those related to muscle weakness and potential conditions like myasthenia gravis, it’s essential to consider several factors. Based on your concerns about noticeable differences in eye size, occasional double vision, and eyelid drooping, let’s break down these symptoms and their implications.

Firstly, the observation of one eye appearing smaller than the other, known as anisocoria, can be benign or indicative of an underlying condition. In your case, if this has been a long-standing issue without any recent changes or associated symptoms, it may simply be a natural anatomical variation. However, if you notice new symptoms such as double vision (diplopia) or significant eyelid drooping (ptosis), it could warrant further investigation.

Myasthenia gravis is an autoimmune disorder that affects neuromuscular transmission, leading to muscle weakness. It often presents with specific symptoms, including fluctuating muscle weakness that worsens with activity and improves with rest. In the context of the eyes, this can manifest as ptosis (drooping eyelids) and diplopia. If you are experiencing these symptoms, especially if they are progressive or associated with fatigue, it would be prudent to consult a healthcare professional for a thorough evaluation.

Regarding your specific symptoms, you mentioned that you do not experience double vision and that your eyelids do not droop significantly. This is reassuring, as the absence of these symptoms makes myasthenia gravis less likely. However, it is still important to monitor any changes. If you notice that your eyelids begin to droop more noticeably, or if you start experiencing double vision, it would be wise to seek a neurological evaluation.

In addition to myasthenia gravis, other conditions could contribute to eyelid drooping or muscle weakness around the eyes, such as thyroid eye disease, which is associated with hyperthyroidism, or other neuromuscular disorders. A comprehensive eye examination, including tests for visual acuity, eye movement, and eyelid function, can help rule out these conditions.

Moreover, if you have a history of poor posture or repetitive strain from work, as mentioned in your initial visit to the neurologist, this could also contribute to muscle fatigue and discomfort, not just in your arms but potentially affecting your eye muscles as well. Eye strain from prolonged screen time or poor ergonomics can lead to symptoms like fatigue, discomfort, and even temporary changes in vision.

In summary, while your current symptoms do not strongly suggest myasthenia gravis, it is essential to remain vigilant. If you notice any new symptoms, such as increased eyelid drooping, double vision, or significant changes in your vision, it would be advisable to seek further evaluation. Regular eye exams and consultations with healthcare professionals can help ensure that any potential issues are addressed promptly. In the meantime, maintaining good posture, taking breaks during prolonged visual tasks, and ensuring proper lighting can help alleviate some discomfort and prevent further strain on your eyes.

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