Droopy eyelids (ptosis)


Ptosis (pronounced toe–sys) is a condition that affects the upper lids to droop to various degrees and this may interfere with the vision or give a tired and sleepy look. It can be present at birth affecting one or both upper lids. It is extremely important for affected children to be examined by an ophthalmologist early on.

What causes ptosis?

In adults, ptosis is usually the result of advancing age. Previous surgery or injury to the eye or eyelids may also cause ptosis and in some cases it may be associated with or a sign of other systemic disorders. Long term contact lens wear can also cause ptosis. This is due to stretching of the muscle caused by repeated insertion and removal of contact lens. Ptosis may be caused by problem in the nerve supply to the muscle that lifts the eyelid. Ptosis present since birth is usually due to poorly developed muscle.

How can ptosis be treated?

It is important to establish the cause of ptosis by careful examination prior to treatment. Not all cases of ptosis need eyelid surgery. Where indicated this condition can be treated with surgery often under local anaesthetic and there is no need to stay in hospital. There are different methods to correct the upper lid position. Here the skin approach is explained which is used most commonly for most common type of ptosis.

Your face is cleaned with antiseptic solution and the upper lid is marked. The local anaesthetic injection is gently given to the eyelid. This causes an initial short lasting stinging for a few seconds. The eyelid will be numb and there will be no pain involved during the operation.  Skin incision is made and the muscle responsible for lid opening (levator muscle) is tightened using absorbable sutures. This may require adjustment and you will be asked to open your eyes to check the eyelid level before closing the skin. The skin is sutured with very fine absorbable sutures. The resultant scar will be hidden away in the natural crease of the eyelid. Antibiotic ointment is put on the eye and the wound and the eye will be padded for approximately 2 hours.

What happens after the operation?

If both upper lids have been treated, at least one of the eye pads will be removed after approximately 2 hours and you can then return home.  The other eye pad should be removed the next day. Your lids will be swollen and the eyes may feel tight to close fully untill swelling settles down. You will be given some eye drops and ointments to put in the eyes for 2 weeks. This is to keep your eyes comfortable and to prevent infection.

What are the benefits of ptosis surgery?

Benefits of ptosis surgery include an improvement of the upper part of your field of vision. There would be restoration of normal appearance of the eyelid as well as improving symmetry with the other eye.

What are the risks of ptosis surgery?

It is common to have some bruising and swelling of eyelids. There may also be some swelling of the eyeball too. These changes will all settle down within a few weeks.

Dry and gritty sensation may also occur. This is treated with lubricating eye drops and eye ointments. This again, will settle down after a few weeks. The vision may be blurred for a few days.

Any bleeding following surgery is usually slight and stops within a short time. In case of continuous bleeding you should seek urgent advice from the hospital.

Wound infection causes swelling and tenderness of the wound with poor healing. Antibiotics tablets are required to treat this and re-suturing of the wound may be necessary once the infection has settled.

Problem with complete eyelid closure will occur if the eyelid is lifted too high. If this is mild, massage and traction may be adequate to lower the eyelid. In more severe cases of overcorrection a further operation to lower the eyelid is required soon after the initial surgery.

Poor contour of the eyelid may also require further correction. Undercorrection of ptosis where the eyelid is still low after surgery may also require further surgery.

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