Ptosis surgery and the different types of ptosis
What s ptosis?
Ptosis surgery is the medical name given to repair a droopy eyelid. The droopy eyelid causes ptosis which can affect the vision from the top part of the eye and give a sleepy or tired appearance. You may have difficulty keeping your eyes open as a result of having ptosis which can lead to symptoms of eye strain, an ache in the eyebrow as you start to use the muscles of the brow to keep the eyes open and symptoms of tiredness from the extra effort to keep your eyes open.
What are the different types of ptosis?
Ptosis can be present at birth which is known as Congenital ptosis or develop in adulthood which is known as acquired ptosis.
Acquired ptosis commonly develops with long term contact lens use, injury to the eyelid or after cataract surgery or other eye operations. Acquired ptosis may also develop with time and persistent eyelid rubbing is thought to have a risk of developing ptosis. There are less common causes of ptosis and drooping of the eyelid such as problems with the nerves to the upper eyelid or problems with the muscles of the eyelid.
Acquired ptosis can cause a droopy eyelid due a defect in the eyelid muscles or the nerves which can be due to ageing or injury to the eyelid. A rare cause of eyelid droop and ptosis is weakness of the eyelid muscles caused by conditions such as Myasthenia Gravis or Myotonic Dystrophy. If the nerves to the eyelid muscles become paralysed this can cause a droop and ptosis of the upper eyelid. The eyelid can also develop ptosis if there is a weight pulling the eyelid down such as a large cyst or swelling of the eyelid.
Congenital ptosis where a droopy eyelid is present at birth may be a purely cosmetic concern affecting the appearance of the child but it can affect the visual development in which case surgery is required in childhood to correct the drooping of the upper eyelid. Surgery in childhood is also considered if there is an issue with confidence of the child and issues of bullying at school affecting their educational development.
What is Marcus Gunn or Jaw winking ptosis?
Marcus Gunn or 'Jaw Winking Ptosis' is where the droopy eyelid rises with the opening of the mouth and jaw or when chewing. It is usually noticed in children and most commonly affects one eye only. It is caused by an abnormal connection of the nerves. Although is only affects one eye performing surgery on the affected eye may result in drooping of the other eye. In such cases ptosis surgery is needed on both eyes to correct the eyelid drooping. Whether this is necessary will be clarified by your doctor.
What type of surgery is done for ptosis?
There are different types of surgery done to treat ptosis and treat the drooping of the eyelid depending on the cause. If there is a ptosis and your doctor finds that the eyelid muscle is working well then surgery is done to shorten the eyelid muscles and tendons to bring the upper eyelid up and correct the droop. If there is ptosis and the eyelid muscle is not working well then the eyelid is suspended from the eye brow in order to provide the lift required to treat the ptosis.
Why is Ptosis surgery done for a droopy eyelid?
Ptosis surgery is the surgical treatment to lift the eyelid back to a normal position. This treatment helps improve the vision caused by the eyelid drooping over the eye. It may also be done for cosmetic reasons if there is no blockage of vision to give a more youthful and left tired appearance and treat any aching in the eye brows as they strain to lift the eyelids. In children ptosis surgery is done to help improve the vision and treat any issues of bullying and its effect on their educational development. Ptosis surgery can also help improve a person's confidence.
What are the risks of the surgery?
Possible risks of ptosis surgery include:
Bleeding from the surgery
Dryness and irritation of the eyes
Difficulty closing the eyes
Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)
Drooping of the other eye if one eye is treated
A need for follow up surgery
Temporary blurring of the vision
Rarely, loss of vision
Risks associated with surgery more general including anaesthetic reactions and blood clots
To know which risks most apply to you talk to your doctor to understand more about ptosis surgery as well as the benefits and if they apply to you. This way you can decide with your doctor if ptosis surgery is a good option.
How you prepare for ptosis surgery?
Before having ptosis surgery you will meet your Oculoplastic surgeon who specialises in ptosis surgery to discuss:
Your medical history including any previous surgery and current eye conditions.
Your expectations with an honest discussion about what can be realistically achieved.
A vision examination to check the eyes prior to surgery.
A physical examination of the eyelids to ensure that this is the correct procedure.
Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.
It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during ptosis surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your ptosis surgery and will tell you how long before the operation.
Stoping smoking several weeks before surgery can help improve the healing after ptosis surgery.
You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.
What you can expect before the procedure
Ptosis surgery is usually done as a day case where you can go home the same day. Your surgeon will inject anaesthetic into your eyelids to numb the area and you can also have medication through a drip to help you relax. Mr Ahmad Aziz is specialised in ptosis surgery and is able to give just amount anaesthetic to remove any discomfort whlle not giving too much to distort the results. Surgery is usually done in Central London.
What you can expect during the procedure
If the eyelid muscle is functioning well, your surgeon will make an incision along the fold of the eyelid, shortening the eyelid muscle and tendon to lift the droopy eyelid. As your awake during the surgery they will ask you to look up and down to get the eyelid height just right. The surgeon then closes the incision to give a natural appearance and hiding the scar within the eyelids natural creases to hide the scar as best as possible.
If the eyelid muscle is not functioning well, your surgeon will correct the ptosis by suspending the eyelid to the eyebrow using small incisions in the brow and the eyelid skin crease. The suspension material remains under the skin so that it is not visible.
What you can expect after the procedure
After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.
After surgery you may temporarily experience:
Blurred vision from the lubricating ointment applied to your eyes at the time of ptosis surgery
Watering of the eyes
Sensitivity to light
Puffy, numb eyelids from the anaesthetic and ptosis surgery
Swelling and bruising similar to having black eyes which will settle within a week
Pain or discomfort
Your doctor will likely suggest you take the following steps after surgery:
Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling
Gently clean your eyelids and use prescribed medication.
Avoid straining, heavy lifting and swimming for a week after ptosis surgery.
Avoid strenuous activities, such as aerobics and jogging, for a week.
Avoid rubbing your eyes.
Not to use contact lenses for about four weeks after surgery.
Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
Sleep with your head raised higher than your chest for 3 days after the surgery.
After a few days, return to the surgeon to have stitches removed, if needed.
Seek medical attention immediately if you experience any of the following:
Shortness of breath
An unusual heart rate
Severe new eye pain
Many patients are satisfied with the results of ptosis surgery and benefit from a more youthful appearance, better vision if the peripheral field was being obstructed and more self confidence. The results of the surgery can last a lifetime but for others the drooping may recur with time.
The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases.
Scars from the surgery can take months to fully fade but should be within the skin crease and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.