Eyelid Ptosis Surgery — Causes, Diagnosis, and Treatment
A ptosis of the upper eyelid refers to a droopy eyelid. In essence, the upper eyelid is unable to open fully. In addition to being a cosmetic concern, a ptosis may also cause problems with the vision, especially if the upper eyelids are covering a significant part of your upper visual field. Keep reading to find out more about this problem of the upper eyelid and ptosis surgery.
What Causes a Ptosis?
There can be a number of causes of a droopy eyelid. Not all may require ptosis surgery.
Congenital Ptosis
This refers to droopy eyelids that have been present from birth. The ptosis may be apparent on both sides or just one eye. A ptosis that is present at birth is typically due to underdevelopment of the levator muscle, which is the muscle that lifts the upper eyelid.
Diagnosis
Diagnosing a congenital ptosis can sometimes be challenging in infants and young children. In addition to noticing a drooping eyelid, other signs can include one fold of the eyelid being lower than the other, or the child is constantly lifting their chin to be able to see beneath the lowered upper eyelid.
Treatment
TreatmentIf not treated with prompt eyelid surgery, ptosis in children can cause significant vision problems, such as ambylopia. Amblyopia is also known as lazy eye, and occurs due to a lack of neural input from the eye with the ptosis to the brain during the critical developmental period. If not treated, amblyopia can result in permanently reduced vision.
Children who are compensating for their ptosis by tilting their head may also be at risk of head and neck problems.
Age-Related Ptosis
Another common cause of upper eyelid ptosis is older age. This is commonly called an involutional or acquired ptosis. Due to age, the eyelid muscles, specifically the levator muscle, can become stretched and loosened, making it difficult to lift the upper eyelids.
Diagnosis and Treatment
Your eye surgeon will assess the ptosis and amount that the upper eyelid droops by measuring the eyelid height. If the droopy eyelids are so low that they interfere with your vision, you can elect to have your upper eyelids lifted through ptosis repair surgery. If there is excess skin or skin laxity around your eyelids, this can also be treated and removed through a procedure called a blepharoplasty at the same time as your ptosis surgery.
Some patients with ptosis may not be concerned by their droopy eyelid. If this is the case, it’s not necessary to undergo ptosis surgery if it doesn’t bother you.
Other Causes of Ptosis
Other reasons for a droopy eyelid requiring ptosis surgery can include:
- Injury to the upper eyelid muscle, including the levator muscle
- Disease of the levator muscle and any other muscle that lifts the upper eyelid, such as myasthenia gravis
- Damage to the nerve supplying the muscle that lifts the eyelid
Ptosis Surgery
Most patients suffering from a bothersome eyelid ptosis will benefit from eyelid surgery. However, if your droopy eyelid is due to a systemic disease, such as myasthenia gravis, medications may be more effective. Occasionally, your surgeon may not recommend surgery due to some other reason. Your eye doctor will advise you accordingly based on your circumstances.
The aim of ptosis surgery is to treat the drooping eyelid so that it no longer interferes with your vision. Ideally, the eyelid surgery achieves an equal eyelid margin height between the eyes, but this is not always possible.
What Happens During Ptosis Surgery
Ptosis surgery is usually performed under local anaesthetic, which is injected into the upper lid by the surgeon. Most patients will also be offered a sedative and painkillers. Children are more likely to require full general anaesthetic.
In most cases, the surgeon only needs to make small corrections to the levator muscle. However, in extreme cases, the entire levator muscle may need to shortened and reattached to successfully keep the eyelid lifted when in a normal open position.
An incision is made in the upper lid, usually around its natural crease so that any sutures and the resultant scar will be hidden when the eyelid is open.
After Ptosis Surgery
After your ptosis surgery your surgeon will give you some guidelines to help your recovery. You’ll be asked to use an antibiotic ointment around the incision to prevent infection and maybe also some eye drops in the eye itself. You can expect some swelling and bruising of the eyelids for up to a couple of weeks.
Other Effects After Ptosis Surgery
Though most cases of ptosis surgery recover uneventfully, some patients can experience temporary:
- Dry eye; this can typically be managed with lubricating eye drops
- Difficulty closing the eyelid completely
- Alterations to vision; your prescription may need to be updated
- Numbness of the skin around your eyelid and eyelashes; typically this resolves in 6 to 8 weeks
In cases where eyelid surgery is performed on only one eyelid, you may find the other eyelid begins to droop. If this becomes a problem, you may ask your surgeon about droopy eyelid surgery to keep that eyelid lifted.
Complications of Ptosis Eyelid Surgery
The vast majority of ptosis surgery cases are able to successfully treat ptosis with one round of surgery. However, in some cases it may be necessary to undergo a second ptosis operation.
Reasons for a Second Ptosis Eyelid Operation
- If the eyelid and muscle are lifted too high
- If the eyelid is not lifted high enough and either continues to interfere with vision or continues to appear significantly asymmetrical
- If the shape of the eyelid is not quite right
Potential Complications of a Ptosis Repair
As with any operation, there are risks associated with eyelid surgery.
General Risks
Risks of any operation include:
- Bleeding
- Infection
- Allergic reaction to the local anaesthetic or medical materials used
Risks Specific to Ptosis Eyelid Surgery
- Over or undercorrection of the levator muscle
- Bleeding into the eye socket
- An unsightly scar
- Irritation from the sutures
In order to avoid complications as much as possible, it’s important to disclose your full medical history to your eye doctor so that your risk factors can be identified and managed ahead of your ptosis operation. Or you can simply contact Armadale Eye Clinic on (03) 9070 5753, and we’ll be glad to answer all of your questions.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
Sources
Ptosis.
https://eyeandear.org.au/patients-visitors/fact-sheets/ptosis/
Ptosis (drooping eyelid).
https://www.rch.org.au/kidsinfo/fact_sheets/Ptosis_drooping_eyelid/
Ptosis surgery (adult).
https://www.healthdirect.gov.au/surgery/ptosis-surgery#what-is
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