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Adult Age Related Ptosis

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What is Ptosis?
Drooping of the upper eyelid is called ptosis. It can affect one eyelid or both. A small degree of asymmetry is common and a small degree of ptosis may not need treatment. It is commoner in older people due to the weakness of the muscle which lifts the eyelid. Some children are born with a drooping eyelid due to the muscle not developing correctly. It may be due to injury and can sometimes follow recurrent lid swelling from allergic disease . If it becomes severe the visual field may be reduced or the lid may cover the eye completely. Surgery is the main mode of treatment.

INDICATIONS FOR SURGERY
Ptosis surgery is indicated if there is significant visual field hooding or symptoms.

The operation

The operation is done as a day. After administration of local anaesthetic, an incision is made along the upper lid. Excessive skin may also be removed in some cases. The upper lid muscle (levator muscle) may be shortened or re-attached to the eyelid and all the stitches used to complete the surgery are dissolvable and don’t need to be removed. When the affected lid is lifted surgically, the
other lid may drop.

Post-op Care
Your eye will be padded after the operation and you should remove this the next morning. You will need to apply ointment to the eye and lid wound as directed. Vision may be blurry for the first few weeks due to tear film instability and/or lid swelling and your spectacle prescription may change. We normally suggest that you don’t recheck your glasses until at least three months after surgery. As this procedure is functional and not cosmetic, success is considered to be achieved if visual field (hooding) has improved, even though the lids may be asymmetrical in height and/or
contour.

Follow-up
Follow-up appointments are normally made one week post-op to monitor progress. If all is well and second lid surgery is required, you will then be listed for this.

Results / complications
Although the surgery is generally successful the chance of getting the lid height to within 1mm of target is approximately 70%. Lid shape and contour may also alter. All surgery results in some form of scarring. However, this is usually hidden within the natural eyelid skin crease and is not very noticeable. It is likely that for the first few days there will be bruising and swelling. Tight bandaging may be used initially to try to limit this. Although the success rate is reasonably good, you may need to have further surgery if the first operation lifts the lid too high and exposes the cornea, if the lid is not lifted high enough or if the eyelid contour is very abnormal. Eyelid muscle weakness can affect both eyes. The un-operated eyelid may appear to droop more after surgery to the operated eye.

Surgery may rarely result in bleeding or infection and if the eyelid does not cover the eye properly the cornea may become dry. In severe cases of corneal exposure, the cornea may scar and vision may be reduced It is therefore important to report back quickly if the eye becomes painful or the sight drops after surgery.