Ptosis
What causes Ptosis?
Ptosis can be congenital or acquired.
Congenital Ptsois
If it is present at birth it is called congenital ptosis, and is usually due to poor development of the muscle that lifts the upper eyelid (the levator muscle).
If the ptosis is severe- fully or partially covering the pupil of the eye- it can lead to "amblyopia" (lazy eye) or strabismus (eyes that are not properly aligned or straight). In some cases the ptosis is also related to refractive errors or astigmatism (an irregularity in the shape of the cornea that causes blurred vision).
Acquired Ptosis
Most cases of acquired ptosis are characterised on the basis of the history. ‘Neurogenic’ ptosis is caused by a partial or complete paralysis of the nerve innervating the levator muscle. ‘Myogenic’ ptosis can be caused by facial weakness (such as in myotonic dystrophy). ‘Traumatic’ ptosis can be induced by trauma to the eyelid, and in ‘mechanical’ ptosis the upper eyelid may be prevented from opening completely because of, for example, an eyelid tumour which restricts the action of the levator.
Another form of acquired ptosis is ‘dermatochalasis’, which is the presence of excessive and redundant eyelid skin and is almost always progressive with ageing. Surgical correction may be indicated for visual or cosmetic reasons.
What are the symptoms of Ptosis?
The foremost symptom of ptosis is an eyelid that sags or droops. Patients will often tilt their heads back or lift their eyebrows, in an expression of surprise, in order to see (especially if bilateral ptosis is present).
Among other symptoms, lax eyelids may cause headaches and browaches, obscure the vision or irritate the eye.
How is Ptosis treated?
The treatment of ptosis is largely surgical. Ptosis surgery is designed to tighten the levator muscle by shortening it to allow the muscle to sufficiently elevate the eyelid. The eyelid is often carefully compared to the opposite eye in terms of lid height. In some cases where the levator is exceptionally weak the eyelid is attached to the brow muscles, with a ‘levator sling’, allowing the forehead to elevate the lid.
Ptosis surgery is usually completed under general anaesthesia in infants and young children and under local anaesthesia with sedation in adults. Ptosis surgery in adults is performed here at Harley Place Day Surgery on a same day outpatient basis.
What can I expect after surgery?
After the procedure you will likely experience some discomfort and the upper eyelid/s may feel ‘tight’ at first, although this sensation should resolve within a few days. The elevation of the eyelid will often be immediately noticeable, though in some cases the bruising and swelling associated with the surgery will obscure this finding. The bruising and swelling will usually resolve in 2-3 weeks.
Dr Martin will prescribe antibiotic ointment and drops as your eyes may feel sticky, dry and itchy for up to a week following surgery. Any other medications will also be prescribed if you are experiencing discomfort.
Most patients will have sutures that need removing about a week following the surgery. In some patients, such as children, absorbable sutures are often used. At 5-7 days post-op, reassessment is made and if there is over-correction or under-correction of the lid, adjustment of the sutures may be necessary to better align the lid height.
Whether ptosis surgery is for medical or cosmetic reasons, it is usually a straightforward surgical procedure with a high rate of success.
