Guest post by Dr Ye Chen, Oculoplastic and Lacrimal Specialist
What is ptosis?
Ptosis is the medical term for drooping of the upper lid. It can be present in one or both eyes.
A droopy lid can interfere with vision by affecting the top part of the visual field and can also cause fatigue and eyebrow ache especially when reading.
Ptosis can either be present at birth (congenital), or may occur later in life (acquired).
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Why is ptosis repair necessary?
Ptosis repair is performed to lift up the eyelid enough to stop it from causing problems with vision. The ideal result is when:
● The lid sits at a normal level
● The level matches the level of the other lid
● The lid has a natural curve or contour, which matches the other lid
● The eye closes fully and is comfortable
(Image courtesy of Minnesota Eye Consultants)
What does ptosis repair involve?
Ptosis surgery usually involves re-attaching or shortening the muscles or tendon that raise the lid. This is done using sutures, which are buried under the skin.
The skin incision is made in the existing eyelid crease (skin fold) and sutures may be visible on the skin of the eyelids after the operation. The skin incision sutures will be removed at around one week after surgery.
Occasionally the lid is suspended from the brow in order to raise it.
The operation takes about 45-60 minutes per eye as a day case procedure, with no need for an overnight stay in hospital.
If both eyes have ptosis it is usually best to operate on both sides at the
same time to give the best chance of a symmetrical result.
It is usually done with the patient awake (with the use of numbing local anesthetic injections and sedation tablets). This minimizes discomfort and at the same time allows for judgment of the lid position during surgery (you will be asked to open and close your eyelids from time to time).
What are the potential risks?
About 80- 85% of patients are corrected satisfactorily after the first operation. Approximately 15–20 % may require further surgery.
● Irregular curve of the lid
● Asymmetric upper lid fold of skin
● Soreness and discomfort The eye lid and may feel sore and a little numb above the lashes for a few weeks. Bruising of the eyelids and surrounding face is common for up to a couple of weeks after surgery.
● Undercorrection, where the eyelid is still too low after surgery. This often resolves after the tissue swelling decreases. If the eyelid is still significantly droopy after 6 weeks or so, a second surgery to adjust the lid height will be required.
● Recurrence of the ptosis. The droopy eyelid can reoccur at any time in the future despite initial successful surgery. This may require a repeat procedure to correct again, but repeat surgery can be more complicated to undertake.
● Overcorrection, where the eyelid is too high after surgery. If the eyelid is overcorrected, massaging the lid and pulling it down in a special, controlled manner can help to lower the lid. However, further surgery might be necessary to lower the eyelid later. Ointment is often required at night if the eyes are not closing properly while sleeping.
● Lid lag, where the lid can fail to look down. This can give the eyes a gritty sensation and make them red and sore. Patients with dry eyes may feel the dryness worsen after surgery.
● Lagophthalmos. This is the inability to close the eye and can occur particularly after large ptosis corrections. This usually corrects itself with time as the eyelid muscles relax.
● Bleeding and infection are also potential risks, but are less common.
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What can I expect?
Blood thinning medications such as aspirin, clopidrogel (Plavix, Iscover) and warfarin can make bleeding more likely during and after surgery. If you are taking these medicines, you will be told if and when to stop them prior to surgery surgery.
You should also stop anti-inflammatory drugs like ibuprofen (Nurofen) and supplements containing fish oil, ginger, ginseng and garlic 2 weeks before surgery.
If you smoke it is strongly recommended that you stop smoking for at least 3 days prior and 1 week after surgery. This is important as smoking impairs wound healing and increases the risk of infection.
Avoid alcohol for a day before and a day after surgery.
If you are having sedation or general anesthetic, please fast and have nothing to eat or drink for at least 6 hours before surgery.
On the day of surgery, please dress casually and wear a top which buttons at the front. Please wash your face on the morning of surgery and ideally men should shave.
Do not wear any makeup, jewellery or contact lenses.
(Image courtesy of Dr Ye Chen)
If both upper lids have been treated, at least one of the eye dressings will be removed after an hour and you can then return home to rest. Any remaining dressings should be removed the next day.
Icepacks can be used to help reduce the swelling. Other ways of reducing swelling include sleeping at a 45 degree incline and avoiding sleeping on the operated side.
It is often advisable to keep the operated area relatively dry for at least two days although showering is permitted.
Swimming, contact lens wear, and eye make-up is not advised for approximately 2 weeks, and longer if the eye remains red.
Avoid sun exposure by wearing a hat or dark glasses for up to 6 months.
You will usually need about one week off work. Try to avoid driving for a few days after the operation.
You will be given drops and ointment to use after surgery.
You will be given a clinic appointment for one week after surgery with a second appointment between 10 to 12 weeks later. At the second postoperative visit, the swelling in the lid should have gone down and a more accurate assessment of the outcome of surgery can be made.
Stitches are sometimes left to dissolve or are removed at about one week after surgery.
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