Wednesday, February 03, 2010

On the Drooping Eyelid

Who'd have expected, drooping eyelid could actually means some very severe condition which puts the patient in a position where death could happen anytime.

Apparently too, high blood pressure is not something to be taken lightly. The patient that I clerked for my case write up had hypertensive urgency which saw her presented to the trauma and emergency centre. But after her blood pressure was lowered, she was dischared. 3 days later, her left eyelid started to droop. Her left eyeball was fixated, she couldn't move her eyeball. And so, she went to the trauma centre again, which saw her being referred to the physician the next day, and was admitted straight away.

video

So, what was thought to just be a normal hypertensive urgency, apparently led to an aneurysm formation in one of the arteries in her brain, which compresses on the nerves to the eye, leading to the drooping of the eyelid, what we call, isolated 3rd cranial nerve palsy secondary to posterior communicating artery (PCOM) aneurysm. *cheehwah... bombastic*

Anyway, this isn't actually an eye problem. But since she was admitted to the eye ward, and presented with the eye, so I wrote about her anyways.

During the viva I had with the professor last Friday, she asked me about her progress and all. I supposed she was amazed that I followed up on her, because the previous 2 colleagues that wrote on the same case didn't even check up on her CT scan!

So, prof was saying something like, the doctors in the ED didn't picked up that it was PCOM aneurysm, but the physicians did a splendid job. Instead of referring her to the eye clinic for the drooping eyelid, they suspected aneurysm, which could rupture anytime.

I wonder if I could pick it up that fast next time.

Anyways, the patient was finally referred to the neurosurgical team, I supposed surgery was done soon after. Hopefully she's all fine.

ps: Watch the vid, it's AWESOME! Doesn't require any speakers.

8 Jujus:

manglish said...

hmmmm there is more than meet the eyes.....

reanaclaire said...

talking about eyes, my young sister has problem with both of her eyes.. diagnosed as in layman's terms, one eye permanently damaged and one eye, retina dropped.. i wonder what that means.. she told me the doc put "oil" on her retina problem eye and wait for another 6 months to see what's next.. i really worry for her, at such a young age, she is now partially blind..can only see 30% on one eye.. due to diabetes..

the happy go lucky one said...

wowww... im amazed! lucky her to have caring and good doctors around :)
and keep up ur caring heart and effort to benefit more ppl :)

Medie007 said...

manglish, yeaps definitely...

reanaclaire, how young is your sis? diabetes could cause tractional detachment of the retina. has she undergone any operation or something? if it's wat i think it is, prolly the oil was there to push the retina back to the base of the orbit, but that's if she had undergone vitrectomy.

happy, me? caring? no lah. :P

Gratitude said...

Thank you for all the interesting writeups. Give us MORE! ;)
+Ant+

foongpc said...

This post is very informative! I didn't know such a condition exists!

叶子 said...

very good post. thanks for sharing!!!

mintradz said...

I think this is more likely a case of Ptosis. The most obvious sign of ptosis is the drooping eyelid. Depending on how severely the lid droops, people with ptosis may have difficulty seeing. Sometimes people tilt their heads back to try to see under the lid or raise their eyebrows repeatedly to try to lift the eyelids. In addition, Arizona eye care said that this condition also can be caused by a problem with the muscles lifting the eyelid, called levators. Sometimes a person's facial anatomy causes difficulties with the levator muscles.