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Eyelid Ptosis |
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Departments & Services > Surgery > Ophthalmology > Education > Eyelid Ptosis |
Eyelid Ptosis
Ptosis is a medical term for a droopy upper eyelid which can occur at birth or later in life. The cause of ptosis frequently cannot be determined, but may be hereditary factors, eyelid injury or neurologic problems. Symptoms of ptosis include decreased ability to see objects about eye level, difficulty wearing contact lenses and eyestrain from the increased effort needed to raise the eyelids. In addition, many patients complain that their eyes have a tired, fatigued appearance from "droopy eyelids" even though they are well rested. Although there is a definite improvement of appearance from correcting ptosis, the main reason for correcting the droopy eyelid is to improve vision in the upper field of gaze. Because medication is ineffective in the treatment of ptosis, various types of upper eyelid surgery are required.There are two basic operations to correct ptosis. The strength of the muscle in the eyelid (the levator muscle) determines which operation is to be used. If there is some strength to the muscle in the upper eyelid which elevates the eyelid, the person has "good" levator function. The muscle itself can be tightened or resected according to a formula to elevate the eyelid to the desired position. If the person has poor levator function or poor strength of the muscle, then tightening or resecting the levator muscle will do no good. The ptosis must be corrected by attaching tiny strands for the eyelid to the brow so that the person can use the brow muscle to open the eyelid. These tiny strands are tunneled underneath the skin and are not visible. This is called a "frontalis suspension" operation. The material used for the attachment is either silicone threads or the body's own tissue, consisting of small strips of "fascia" (a tendon-like material) taken from the side of the leg through a small incision.
Regardless of the type of surgery used, postoperatively the eyelid is at the desired level and the person can open and close his/her eye in a normal-appearing manner. However when the person goes to sleep and the facial muscles relax, the eyelids will tend to separate because of the tightness of the shortened muscle. As long as the ocular protective mechanisms and tears are normal, no dryness of the eye results from the separation.
What to Expect After Surgery
Following surgery either pressure bandages or ice compresses are used. Stitches usually will be placed where the normal position of the upper eyelid crease should be. If the frontalis suspension is used there may be some additional stitches above the brow. These stitches will dissolve or may have to be removed in approximately one week. After surgery, a lubricant may be used in the eye at night. This may be necessary because immediately after surgery when the eyelid is swollen there is a good bit of stiffness of the eyelid. When the stitches are gone the swelling will subside rapidly and the tissues will soften. The final result usually is obtained in six weeks. During this time warm compresses with hasten healing.
Occasionally adjustments or touchup work need to be done to alter a contour or to adjust the eyelid level or position. Fortunately, in our hands, this is not common, however throughout the country there is an incidence of approximately 25% of some need for adjustment. This can be done easily in the office in most cases. If adjustment is necessary in children, they most come tot he hospital for outpatient anesthesia.
