Droopy Eyelid Ptosis

Ptosis is the term for drooping of the upper eyelid. This can occur from neurologic, neuromuscular, or mechanical causes as well as from injuries or ageing changes. Ptosis can also occur following routine cataract surgery.

Ptosis may affect one or both eyes and can be very asymmetrical depending on the underlying cause. The most common cause of ptosis is loosening or detachment of the eyelid tendon. This occurs primarily in people greater than forty years of age and the incidence increases with age. Ptosis may also occur in younger people who wear contact lenses. Congenital ptosis is present from childbirth. It may involve one or both upper eyelids and vary in severity from mild to severe. This type of eyelid ptosis is often the result of incomplete development or abnormal nerve connections of the levator muscle.

Treatment is primarily surgical for both adult and congenital ptosis. The goal is to tighten the muscles so that the lid is elevated to match the lid on the other side, but with minimum scars and side effects. Neurologic and neuromuscular cases may improve spontaneously or respond to treatment of the underlying cause.

A drooping eyelid is the main feature of ptosis. Adults may also notice a loss of the upper field of vision and sometimes difficulty in reading. Children with congenital ptosis often tilt their heads back or raise their eyebrows to lift the eyelid.

When a neurological disorder is present, symptoms typically include visual complaints independent of the droopy eyelid. Difficulty in reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well.

Risks of surgery
All surgery carries some uncertainty and risk 
When eyelid surgery is performed by a qualified oculoplastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, asymmetry, etc.

There is a possibility of over or under correction, which may require another operation.

Preparing for surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

Types of anaesthesia
Eyelid surgery is usually performed under local anaesthesia, which numbs the area around your eyes.

The surgery
An incision is made in the upper lid skin-crease. The levator muscle is identified and re-attached to the lid and the incision closed with a few sutures. For congenital ptosis, the procedure may be similar to that in adults or it may involve attaching the upper lid to the brow muscles with fascia taken from the patient’s upper leg.

After surgery
After surgery, you will be asked to lubricate your eyes with drops or ointments. Your eyelids may feel tight for a few days. Swelling and bruising generally last about seven to ten days

The stitches will be removed a week after surgery.

Getting back to normal
You should be able to read or watch television after one or two days. However, you won't be able to wear contact lenses for about three weeks. Most people feel ready to go out in public (and back to work) in about 10 days.

The new look
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they should fade to a thin, nearly invisible white line.