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Ptosis is a term used to describe
weakness of the muscle of the upper lid. This can happen for a
variety of reasons. Your surgeon would have explained the likely
cause of your eyelid ptosis. The end result is that the upper
eyelid droops to the extent that it covers the pupil or affects
the upper field of vision. At this stage many patients are
troubled enough to ask for a remedy. There is no danger to the
eye itself if left untreated. This is not the case in childhood
ptosis. If a child is born with a droopy eyelid that covers the pupil, surgery needs to be done rather urgently to uncover the pupil otherwise the vision will not develop in the affected eye. If the pupil is not covered however, it is safe to wait until the child is of school age. The child however must remain under the close observation of the hospital until that time. The technique used to correct the ptosis depends on the amount of viable muscle. If the muscle is deemed to have reasonable function then the procedure would involve shortening of the muscle and thereby strengthening it. This can be done either from inside or through the skin. We often find that an operation from under the surface and with 3 sutures brought forward through the skin, performed under local anaesthesia, yields a good predictability of outcome (our results are 92% successful) and at the higher end of the national and international average, surgery through the skin also has comparable good results. The outcome is less favourable if the muscle is severely abnormal or has not developed as is the case in congenital ptosis or some adult muscular diseases. In these cases one can not get an adequate raise of eyelid by a large amount of shortening of the muscle. One therefore has to use other techniques of suspending the eyelid to the eyebrow muscle using synthetic material or best of all a small strip of the patient's own facia removed from side of the leg. Occasionally children have eyelid ptosis when resting but lid retraction when eating or smiling. Both ptosis and twitch need to be addressed. As the eyelid is raised any excess skin might become more noticeable. The skin can be removed at the same time as correcting the ptosis. Some patients are only aware of one eyelid droop although they actually have bilateral ptosis albeit less in the so called good eye. Once one eyelid is raised the ptosis in the other eye becomes apparent. This would be pointed out to you during your outpatient consultation and means that you might need to have the other eye done in the future if you do not wish to have both eyes done at the same time. SurgeryYour surgeon will explain the exact technique used. The eyelid is injected with a solution of local anaesthesia in adults. The surgery, either through the skin or under the surface of the eyelid is performed. Sutures are normally removed about 1-2 weeks after the operation. The eye will be covered for 24 hours. It is advisable not to drive until the dressing is removed. The swelling and bruising usually lasts about 7-10 days, however if you are planning a social event allow at least a month for full recovery. How to prepare for surgeryYou will be asked to stop taking Aspirin for 3 weeks and
Warfarin for 2 days before your operation if you take either of
these. You must check with your GP to make sure it is safe to do
so. Complications of eyelid ptosis operation:
The alternative to surgery is to do nothing. Surgery can be
done at any time in the future should you change your mind.
This however is not true for very young children with severe
ptosis as explained above. |
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