Ptosis is a drooping upper eyelid, in one or both eyes. It may be easily noticeable, or the eyelid may hang down and cover the entire pupil. Ptosis can affect both children and adults, but most often occurs due to aging.
Symptoms and signs of ptosis
The most obvious sign of ptosis is a drooping eyelid. Depending on how severely the eyelid hangs, people with ptosis may have difficulty seeing. Sometimes you tilt your head back to see under the eyelid or repeatedly raise your eyebrows to try to lift your eyelids.
The degree of drooping eyelids varies from person to person. If you think you have ptosis, you can compare a new photo of your face with a photo that is 10 or 20 years old. You may notice a difference in the skin of the eyelids.
Ptosis can be similar to dermatochalasis, a group of connective tissue diseases that cause excessive skin folds. These disorders are related to an abnormal formation of elastic tissue. Your ophthalmologist can tell you if this is the cause of your drooping eyelids.
What causes ptosis?
Ptosis can be present at birth (congenital ptosis) or occur as a result of aging, injury or a consequence of cataract surgeries and other corrective eye operations.
This condition can also be caused by problems with the muscles that lift the eyelid, known as levators. Sometimes the anatomy of the face creates difficulties for the levator muscles.
Other causes of drooping eyelids include an eye tumor, a neurological disease, or a systemic disease such as diabetes.
Who needs to have a ptosis operation?
Doctors will recommend patients experiencing the following conditions to perform ptosis surgery.
- The eyelids hang too much, which limits vision.
- The height of the eyelid is too low, which makes it difficult for elderly patients to see clearly.
- One of the eyelids is lower than the other, so that it interferes with vision or causes refractive errors.
In addition to health interests, ptosis surgery is often used as a cosmetic procedure to change the shape of the eyelids.
Ptosis surgery can provide an anti-aging effect and remove wrinkles around the eyes.
Some people with different eyelid heights in one eye may be operated on to correct the shape of the eyelids so that they become more symmetrical.
Treatment of ptosis
Eyelid repair surgery is usually performed under local anesthesia around the eye.
This procedure can take 45-90 minutes, depending on the condition of the eyelid that needs repair.
In severe cases, doctors don’t just make a small adjustment, so it takes longer, even when surgery is done on both eyes.
Before performing the operation, you must undergo a full eye examination.
In children, doctors must perform long-term eye examinations before actually deciding that surgery is necessary.
It is important for you to consult further with your doctor about the benefits and risks of complications from ptosis surgery.
Also, tell your doctor about the types of medications you’re taking, including supplements and herbal remedies.
Your doctor will usually ask you to stop taking blood-thinning medications, such as aspirin, to prevent the risk of bleeding disorders.
In mild cases, the eye surgeon will adjust the height of the eyelid to the desired position by tightening the levator muscle.
The levator muscle is a type of muscle that works to move the eyelids.
However, some conditions may require a different method of surgery. The following are three methods that can be performed in ptosis surgery.
- Tightening of the Levator muscle
This method can be applied to patients with strong levator muscle function.
The surgeon will change the position of the levator muscle by placing it on the tarsus, which is the connective tissue of the eyelid.
Ptosis surgery with this method usually gives a higher eyelid so that you see better. The result of the operation also gives a more attractive eyelid shape.
- Eyelid muscle shortening
In this procedure, the doctor will turn the eyelids inward.
The doctor will also shorten the levator or Mueller muscle, which is the muscle that also plays a role in lifting the eyelid, from the inside of the eyelid.
If only a small part of the cap needs to be raised, the doctor will usually cut off the Mueller muscle.
Instead, the doctor will shorten the levator muscle when the eyelid needs to be raised higher.
- Installation sling
If the function of the eyelid muscles is weak, the doctor must adjust the position of the eyelids by placing an instrument in the form of a sling.
In this ptosis surgical method, the doctor will attach the upper eyelid to the frontal muscle, which is the muscle just above the eyebrows.
To do so, the doctor will pair the sling It is a small silicone rod that runs through the bottom of the eyelid.
This tool will connect the eyelids to the frontal muscle, causing the forehead muscles to become strong enough to lift the eyelids higher.
Once the surgery is complete, your doctor will usually let you go home within a few hours.
You may have difficulty closing your eyes or lowering your eyelids, making your eyes more likely to become dry.
This condition is a common side effect of postoperative ptosis experienced by both children and adults.
In addition, you may experience other side effects such as:
- eye pain,
- light bleeding and
- infection of the surgical suture.
Some symptoms may not completely disappear two to three months later.
But don’t worry, the doctor will give you eye drops and ointments that can keep your eyes moist during the recovery period.
These drugs also reduce the risk of eye infections that can occur due to eyelids that are difficult to close.
Risks of ptosis surgery
After surgery, the eyelids may look asymmetrical, even if they are located higher than before the operation. In very rare cases, eyelid movement may be lost.
It is important to choose the surgeon with care, as a poorly performed operation can result in an unwanted appearance or dry eyes because the raised eyelids do not close completely.
Before deciding on a ptosis surgery, you should ask the surgeon how many such procedures he or she has performed. Also, ask to see photographs of former patients before and after and ask if you can talk to any of them about the experience.
Ptosis in children
Children born with moderate or severe ptosis must undergo surgical treatment in order to develop good vision. If not treated, ptosis can lead to amblyopia (impaired vision in one eye) and a lifelong poor vision.
All children with ptosis, even in mild cases, should see an ophthalmologist every year. As they get older, the eyes change shape and sometimes vision problems can occur if the ptosis worsens.