Ptosis Repair

Ptosis (pronounced toe-sis) refers to the drooping of the upper eyelid caused by a weakened muscle that is responsible for raising the eyelid. A person with ptosis is not able to adequately raise the eyelid and fully open the eye. This causes the edge of the upper eyelid to hang down too far, which creates a tired appearance or can obstruct vision. Repairing ptosis, whether for medical or cosmetic reasons, requires surgery.

What Is Ptosis Repair?

The actual ptosis repair procedure depends on the main cause of the ptosis. Two of the most common types of ptosis are involutional ptosis and muscular ptosis.

In involutional ptosis, the tendon that supports the levator muscle (main eyelid opening muscle) has slipped or become stretched and weakened, thus reducing effective muscle movement. Usually caused by aging, it can also be caused by long-term wearing of contact lenses, excessive rubbing of the eyelids, trauma, or other conditions. Involutional ptosis is corrected by tightening the levator tendon via a skin incision or an incision hidden on the backside of the eyelid.

In muscular ptosis, the levator muscle itself is weak. This is typical of congenital ptosis found in children, which needs to be corrected to prevent the development of amblyopia. Muscular ptosis is also common in adults with neuromuscular issues such a third nerve palsy or chronic progressive external ophthalmoplegia (CPEO) among others. The type of muscular ptosis surgery performed depends on the degree of muscle weakness. If the muscle retains some function, it is tightened to improve eyelid position. If there is poor muscle function, the ptosis is corrected by a technique known as a frontalis suspension. In this procedure, the eyelid muscle is connected to the eyebrow (frontalis) muscle using a sling material that allows the eyelid to be raised and lowered using muscles in the forehead.

Are There Any Risks with Ptosis Repair Surgery?

As with any surgery, there are risks associated with ptosis surgery. Your surgeon will discuss the risks with you in detail, but risks can include:

• Bruising or swelling after surgery
• Infection
• Need for adjustment or additional surgery
• Asymmetric eyelid height
• Overcorrection or under correction
• Dry eyes requiring lubricants

Preparing for Ptosis Repair Surgery

Prior to ptosis repair surgery, your surgeon will need to determine as best as possible the likely cause of the ptosis, as well as how severe it is. A comprehensive eye examination will be essential, including a close physical examination of the eyelids, a visual acuity test, and taking a family health history. The distance between the corneal light reflex of the pupillary center and the margin of the upper eyelid (known as marginal reflex distance-1 or MRD-1) will also be measured to determine the amount of droop and level of visual obstruction. Visual field testing may be employed to demonstrate an improvement in the peripheral vision with elevation of the droopy eyelid. These tests are important for proving a medically necessary benefit to your insurance company.

Ptosis Repair Recovery

After ptosis repair surgery, your eyelid may be swollen and bruised. It is important to keep your head elevated and use cold compresses to reduce swelling. Too much swelling can stretch the sutures and cause your eyelid to droop again. You will be given lubricating ointment or drops to keep your eye hydrated and may be given antibiotics to prevent infection. Your surgeon will see you seven to 10 days after surgery to evaluate your recovery. It may be weeks to months before the final results of the surgery are noticeable. Your doctor will provide you with detailed recovery instructions. Some post-operative consultations can be performed via telemedicine depending on your individual circumstances.