What is Ptosis?
Ptosis is a term used to describe the drooping of the upper eyelid. It is a condition that can affect one or both eyes. Ptosis can be mild when the eyelid is above the pupil, or can partially cover the pupil; therefore, blocking the upper part of your visual field. In severe cases, the eyelid fully covers the pupil.
Why does it occur?
Ptosis that has been present from birth is called congenital ptosis. Ptosis can be congenital when the muscle lifting the eyelid up has not developed enough. The tendon of the elevator muscle pulls away from where it attaches to the eyelid and as a result, the eyelid falls down. This is the most common cause (aponeurosis dehiscence) and affects contact lens wearers more.
Treatment
Surgical correction is required to repair the drooping upper lid. Surgeons who specialise in this type of corrective surgery perform this operation mostly under local anaesthetic but general anaesthesia is sometimes used. This is a meticulous operation that can take approximately 45 minutes – one hour for each eye.
The operation may be done externally (anterior approach) with a cut along the upper lid skin crease, or from inside of the eyelid (posterior approach). If the eyelid muscle is too weak, a sling will be necessary and this is passed from the upper lid to the brow/forehead to produce a lift. Removal of loose skin with a blepharoplasty may also be needed.
Complications
Swelling, bruising and blurry vision are common after ptosis repair. Stitches are removed 5-7 days after surgery, except in the cases where self-dissolving sutures are used.
Other possible complications associated with ptosis surgery include:
- bleeding and swelling;
- delayed healing;
- scarring;
- infection;
- residual drooping of upper eyelid or retraction
if lifted too much; - residual asymmetry;
- drooping of the eyelid of the non operated eye
due to common innervation; - double vision; and
- dry eye.
Rarely, a bleed tracking to behind the eyeball (retrobulbar bleed) can occur, which can threaten your sight. It is important to note that normal wrinkling and aging of the eye area will continue.
Smokers are known to have healing problems. Please let your surgeon know if you are a smoker or ex-smoker.
Further resources
Patient information leaflets section on the Leeds Teaching Hospitals NHS Trust website