Ptosis repair refers to surgical procedures conducted to lift a droopy upper eyelid into proper position.
Ptosis is an abnormality where the upper lid closes involuntarily or droops such that it partly covers the pupil and may obstruct vision. It can also occur intermittently, making it difficult to diagnose it accurately. The problem may affect one or both eyes, causing the patient to appear sleepy or tired, and reduce vision.
The abnormality may occur in childhood or adulthood due to a functional or anatomical disorder in the levator muscle. Various factors can cause it, including:
- The gradual stretching or weakening of the tissue from aging, or long-term, rigid contact lens wear. It’s known as levator aponeurosis and is the most common form of acquired droopy eyelid
- Nerve damage in the area of the muscle
- Natural levator muscle weakness causes congenital ptosis
- Certain medical conditions such as:
-Tumor in the eye area
-Stye on the eyelid
The correction is suitable for healthy children and adults to improve eyesight where the droopy eye affects vision. It can also be done for cosmetic reasons, i.e., for a more vibrant and youthful look.
Also Known As
- Droopy Eyelid Surgery
Preparation & Expectation Before Surgery
The surgery usually requires extensive experience and is done by a surgeon specializing in eyelid surgery (ophthalmologist). Before the procedure, the surgeon has to establish the cause and severity of the disorder. S/he will conduct a comprehensive eye examination including taking a family health history, a visual acuity test, a close physical inspection of the eyelids, diagnostic tests to check the strength of the levator muscle, etc.
The eye exam results help the surgeon to determine the most suitable technique for the patient. Usually, the procedures to correct ptosis are conducted in an outpatient setting and take about an hour to complete. The eye appearance should remain consistently better than it was before the treatment.
Types, Purpose & Procedure
The type and degree of drooping play a critical role in deciding the best treatment technique. There are two primary ptosis surgery options:
The general technique which involves tightening of the levator muscle.
It has two approaches namely, external and internal methods.
i. The external approach is also known as levator advancement. It’s the most frequently employed method and is useful where the patient has a normal levator function and high upper eyelid crease. During the procedure, local anesthetic with sedation is injected to calm the nervous system and block pain. The surgeon cuts the natural crease of the upper eyelid and repositions the levator muscle attachment to the connective tissue in the eyelid. The patient may be required to perform specific eye movements throughout the operation to determine the best eyelid position.
ii. The internal method also focuses on the levator muscle and is done by turning the eyelid inside out. The technique enables the surgeon to observe both the Mueller’s muscle and the levator muscle, which lift the eyelid. Where only a small lift is needed, s/he may tighten the Mueller’s muscle. S/he shortens the levator muscle when a more significant lift is necessary. The surgeon may administer general sedation or anesthesia during the operation.
The Sling technique
It’s also known as frontalis sling fixation and involves the lifting of the eyelid using the frontalis muscle. The procedure is considered when a patient has a weak levator muscle function and ptosis, such as congenital ptosis, neurogenic ptosis, or myogenic ptosis. In this method, the upper eyelid and the frontalis muscle are attached using a small silicone sling. It allows the eyelid to be lifted and lowered by raising and lowering the eyebrows. The procedure is suitable for both children and adults and is conducted under general anesthesia.
Risks, Side Effects & Complications
The risks of droopy eyelid surgery include:
- Dry eye
- Scratched cornea
- Asymmetric eyelid height
- Dry spots needing lubricants
- Stiffness of the eyelid in downgaze
- Under correction or overcorrection
- Swelling or unusual bruising after surgery
- Need for additional or adjustment surgery
After the surgery, the eyelid may appear bruised and swollen.
Abnormal swelling can stretch the sutures resulting in a drooping eyelid again.
After Care, Recovery & Outcome
It’s essential to use cold compresses to reduce swelling and to keep the head raised. The surgeon will give lubricating drops or ointment to keep the eye hydrated and prescribe some antibiotics to prevent infection. S/he may need to see the patient seven to ten days after surgery to assess the recovery.
The recovery happens in stages, and the surgeon will provide detailed aftercare instructions.
Some helpful tips to aid in faster recovery include:
- Avoid smoking
- Don’t rub the eyes
- Use ice packs as recommended
- Wear sunglasses to protect the eye area
- Avoid contact lens wear until the doctor allows it
- Keep the head raised while sleeping for several days
- Follow all the post-surgical instructions given by the doctor
- Avoid straining, swimming and heavy lifting for the recommended period
- Clean the surgical site per the surgeon’s instructions using only the approved cleansers
It may take up to three months before the complete results of the surgery are noticeable. In many cases, revision surgery involving a few small adjustments helps to improve the results. In other cases, the initial procedure is repeated for a satisfactory outcome.