See an expert for ptosis (droopy eyelids) in Nashville, TN.
Ptosis is the medical term for drooping of the upper eyelid. If the lid edge displaces downwards, it can cover part of the pupil and block the upper field of the vision. Symptoms of ptosis include decreased ability to keep your eyes open, eye strain and eyebrow fatigue from the increased effort needed to raise your eyelids, and vision impairment. In severe ptosis, patients have to tilt their head back or lift the eyelid with a finger in order to see well. If the eyelid ptosis is significant, it can cause a visual deficit, a functional problem that is usually covered by insurance to correct the problem with surgery. Mild ptosis can be a cosmetic problem and is not covered by insurance.
Congenital ptosis (present since birth) is due to a poorly developed muscle and can occur in people of all ages. Acquired ptosis is more common in older adults, where the muscle that lifts the eyelid thins and the eyelid drops. It occurs with age, frequent eyelid rubbing, contact lens wear, or trauma. Rarely, a tumor or a neurological problem, such as a nerve palsy or muscle weakness (myopathy), can cause ptosis.
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Eyelid ptosis surgery is usually done under monitored local anesthesia as a same-day surgery. Local anesthetic drops are placed on the eye, and local anesthetic is injected into the upper eyelid to numb the area. A short incision is made in the natural skin crease, and the eyelid-raising muscle (the levator palpebrae superioris) is identified and shortened to lift the eyelid.
What can I expect after surgery?
What are the benefits of ptosis surgery?
What are the possible risks of ptosis surgery?
Can congenital ptosis be associated with other eye problems?
What is the treatment for congenital ptosis?
How is the operation done on children?
What is a sling operation?
What are the benefits of congenital ptosis surgery?
How long is recovery from congenital ptosis surgery?
What are the risks of congenital ptosis surgery?
It is not unusual for the eyelids to have swelling for the first seven to ten days, and ice compresses can aid healing and recovery. Instructions will be given on how to best care for the wound. Lubricating drops and antibiotic ointment are prescribed for best results.
Children with congenital ptosis may also have an amblyopic (lazy) eye, strabismus or squint (eyes that are not properly aligned or straight), or refractive error (need for glasses). Therefore, all children with ptosis should have a thorough eye examination with a refraction by a pediatric ophthalmologist and their team. The oculoplastic surgeon will then see the patient with congenital ptosis and perform eyelid measurements.
Congenital ptosis is treated surgically, and the operation is based on the individual child’s severity of ptosis and the strength of the levator palpebrae superioris muscle. If the ptosis is not severe, surgery can be deferred until the child is three to five years of age. However, if the ptosis interferes with the child’s vision, surgery may be performed at a much earlier age, even as young as three weeks, to allow proper visual development.
Ptosis surgery on a child is done under general anesthetic, usually at a same-day center. The stitches, or sutures, on the skin are usually dissolvable.
A frontalis sling, or brow suspension, is where the muscle of the forehead (frontalis muscle) is used to help lift the eyelid by placing a sling of material, either taken from the child or synthetic, between the forehead and the eyelid. Tissue taken from the child is called autogenous fascia lata and is a small strip of tendon taken from the leg through a 1cm incision just above the knee, on the side of the leg. Alternatively, synthetic materials like silicone, proline, or gore-tex may be used instead.
The upper eyelid may not fully show the final results of the surgery until most of the swelling has disappeared, which can take up to six weeks. After this time, patients will enjoy the full effects of the surgical repair.
These risks are usually not a problem when performed by a skilled surgeon like Dr. Sherman or Dr. Melson, but parents should be warned of the possibilities. The strong protective reflex called Bell’s phenomenon protects the eye's surface with blinking and eyelid closure. As long as the muscle that closes the eyelid is strong, there is usually no risk to vision, especially when regular follow-up eye exams are performed.
