Ptosis treatment
Ptosis (droopy eyelid) Surgery
What is ptosis?
Ptosis is the medical name for the drooping of the upper eyelid, which can happen in one or both eyes.
A low upper lid can interfere with vision by affecting the top part of your visual field. You might also have difficulty keeping your eyelids open, eyestrain or eyebrow ache (from the increased effort needed to raise your eyelids), and fatigue, especially when reading.
What causes ptosis?
Acquired ptosis affects patients later in life and can be due to a defect in the eyelid muscle which can occur with ageing, injury, following long-term contact lens wear, trauma, after cataract surgery or other eye operations. Ptosis can also be present at birth (congenital).
A weakness in the eyelid musclecan also occur in some rare muscle conditions such as myasthenia gravis or myotonic dystrophy.
What will happen at my hospital appointment?
When you are first referred to the eye clinic, an eye doctor will see you in an outpatient clinic. You will have a full eye examination to check your vision and measure the extent of the drooping.
A photograph may be taken prior to the operation to compare the position of the lid after surgery.
What type of anaesthetic is necessary?
In adults, surgery is usually performed with a local anaesthetic (since this allows for judgement of the lid position during surgery). Surgery can also be performed under a general anaesthetic.
Is the local anaesthetic injection painful?
This varies from person to person. A very fine needle is used and there may be a feeling of pain, stinging or pressure which usually lasts less than a minute.
What does ptosis surgery involve?
Ptosis surgery usually involves advancing or shortening the muscle/aponeurosis that raises the eyelid. The muscle is advanced using sutures. The skin sutures on your eyelids usually dissolve in a few weeks. If non-dissolving stiches are used, they will need to be removed at the follow up visit.
Does ptosis surgery have any complications?
There is no absolute guarantee of success with any operation and ptosis surgery is no different.
About 80% of patients are completely satisfied after the first operation. Approximately 20 % may require a further surgery. Complications such as the eyelid being too high or too low, the curve of the lid being irregular or the upper lid fold of skin being asymmetric are some of the problems occurring after ptosis surgery. The droopy eyelid can also re-occur at any time in the future and might require a further operation. Repeat surgery such as this can be more complicated to undertake.
Bruising and swelling of the eyelids and surrounding face is common after ptosis surgery. Bleeding and infection are also potential risks, but are less common.
Inability to close the eye after surgery (lagophthalmos) can occur particularly after large ptosis corrections. This usually corrects itself with time as the muscles relax. If the eyelid is over corrected (too high) after surgery, massaging the lid and pulling it down in a special, controlled manner can be performed to lower the lid if your surgeon thinks this may help. Further surgery might be necessary in very rare instances to lower the eyelid later. Lubricating eye ointment is often required at night if the eyes are not closing properly while sleeping.
After ptosis surgery, the lid can fail to look down (lid lag). Since proper closure of the eyes is necessary to keep the surface of the eye (cornea) moist, it follows that poor eyelid closure will lead to dry eyes. This can give the eyes a gritty sensation and make them red, sore and prone to infection. If the eyes are already slightly dry before surgery, they might be worse after the operation. Often, simple lubrication with artificial tear drops and ointment can help the situation.