What is ptosis?
Ptosis means drooping of the upper eyelid.
What causes ptosis?
The most common cause of ptosis in adults is the separation or stretching of the levator muscle tendon from the eyelid. This can occur as a result of ageing, longstanding contact lens wear, after cataract surgery, or from an injury.
Adult ptosis may also occur as a complication of other diseases involving the levator muscle or its nerve supply, such as neurologic and muscular diseases and, in rare cases, orbital tumors.
What are the signs and symptoms of ptosis?
A droopy eyelid is the primary sign of ptosis. When the edge of the eyelid falls and covers part of the pupil, it blocks the upper field of vision. In severe cases it is necessary to tilt one’s head back or lift the eyelid with a finger in order to see.
How is ptosis treated?
Surgery is almost always required. The main goal of surgery is to elevate the upper eyelid to permit a full field of vision, and attempt to achieve symmetry when the patient is looking straight ahead. The specific operation required is based on the underlying cause of the ptosis, as well as the severity of ptosis and the strength of the levator muscle.
What anaesthetic is used for ptosis surgery?
Ptosis surgery is usually performed under local anaesthesia as a day case procedure with no need for an overnight stay in hospital. Local anaesthesia is achieved with eyedrops followed by injections into the eyelid which make it numb so that little or nothing is felt during the operation.
Other useful facts about the surgery
Ptosis surgery may also be performed in combination with other procedures such as blepharoplasty or browlift. Possibilities can be discussed in detail so that the patient is able to make an informed decision.
What are the risks of ptosis surgery?
A temporary inability to fully close the eye after ptosis surgery is not uncommon. Lubricant drops and ointments are frequently useful in this situation. It is also important to know that although ptosis surgery is extremely successful in achieving symmetrical height and contour of the upper eyelids, there is a small possibility that a degree of asymmetry can arise. If significant, this can usually be easily rectified.
What happens after a ptosis surgery?
Following surgery, the patient will experience some degree of swelling and bruising. It usually takes 2-3 weeks to subside. Cold compresses and elevation of the head are recommended to relieve any discomfort. Wearing make-up or contact lenses should be avoided for at least 2 weeks. The sutures used are usually dissolvable but can be removed after 1 week if necessary. Finally, it is important to avoid strenuous activity for the first week after surgery.
Can ptosis come back?
Yes. Occasionally the upper eyelids can droop again some months or years after corrective surgery. This is uncommon however and most ptosis surgery is permanent.