Mechanical Ptosis in 39-Year-Old Man

A swollen, painful eyelid prompted a 39-year-old man to seek medical attention. The patient had noticed swelling, redness, and irritation in his left lateral eyebrow area 2 days earlier. Upon awakening on the morning of his appointment, the left upper eyelid also felt full and tender and was drooping. A pointed draining area of purulent material had formed in the lateral brow region (not visible here). The patient was afebrile and denied any recent periorbital trauma. He was otherwise healthy; his only medication was a daily multivitamin.

Mechanical ptosis can occur when tumors or edema force the lid to droop. Often the mobility of the eyelid can be impaired. To correct the condition, treat the underlying cause.

This patient was told to use hot compresses to hasten the pointing and resolution of the abscess. Cephalexin was prescribed, because Staphylococcus infections cause the vast majority of abscesses and microabscesses of the lids and periocular area. Monitor such patients for staphylococcal septicemia, orbital cellulitis, and cavernous sinus sepsis.

Reserve incision and drainage for recalcitrant cases. Because the orbital septum acts as an effective barrier to the spread of infection into the orbit, take care not to open it in the course of incision and drainage.¹

REFERENCE:1. Griffith DG, Salasche SJ, Clemons DE, eds. Cutaneous Abnormalities of the Eyelid and Face: An Atlas With Histopathology. New York: McGraw-Hill; 1987:312-316.