Left PtosisPtosis is an abbreviation for blepharoptosis which means droopy eyelids. Patients with this complaint may complain of a " half-asleep " appearance and/or difficulty seeing unless the eyelids are helped open. It is not simply an excess of skin or fat in the eyelids though these conditions may co-exist.
Left Ptosis
Post-Op AppearancePtosis is generally due to either an abnormality of the muscle that opens the eyelid or its attachment to the eyelid. In the most common situation the muscle is normal but has become partially detached from the eyelid, somewhat like a hernia in the eyelid. Most people who develop ptosis later in life have this situation.
In other situations the muscle itself is abnormal and does not contract fully , therefore limiting its ability to lift the lid. This is the case in most people who are born with ptosis , and in a number of rare diseases. The level of function of the muscle in these cases can vary from minimally impaired to no function at all.
Bilateral Ptosis
Post-Op AppearanceThe diagnosis of true ptosis requires a careful ophthalmic examination to exclude secondary causes of a droopy eyelid. The position of the eyelid relative to the pupil in measured in straight ahead gaze and while looking down. ( Some patients' eyelids are in relatively normal position looking straight ahead but too low when looking down , giving rise to the complaint of difficulty reading. ) The distance the muscles that lift the eyelid are capable of moving the eyelid is measured. In rare situations further tests may be required.
Left Ptosis
Post-Op AppearanceMost forms of ptosis can be markedly improved by surgical intervention . Where the muscles that lift the eyelid function normally but have pulled away from the eyelid the prospects for corrective surgery by repairing the " hernia " are very good. Where the function of the muscle is less than normal , shortening the muscle can lift the eyelid to a more normal position, though the degree to which this is possible is a compromise between position while looking straight ahead and ability to close the eyes. However even in cases where the eyelid muscles work minimally or not at all, it is possible to elevate the eyelids by forming an attachment from the eyelid to the muscles that elevate the brow.
Severe Bilateral Ptosis
Post-Op AppearancePtosis surgery is usually performed under local anaesthetic with light sedation which allows the surgeon to "fine-tune" the final position of the eyelid with the patient's cooperation. Children under the age of 12 are mostly treated under general anaesthesia. Most patients can be treated in a day surgery setting.
In older patients ptosis may co-exist with other aging changes in the eyelids namely excess skin in the eyelids (dermatochalasis ) ; fatty deposits in the eyelids ( steatoblepharon )and drooping of the brow ( Brow Ptosis).
When eyelid skin is in great excess this may have to be addressed at the same time as ptosis surgery by way of an operation called blepharoplasty. Often addressing the excess skin or drooping brow may represent an option to enhance the overall cosmetic effect of ptosis surgery.
All patients experience some degree of bruising and swelling after ptosis surgery, the degree of which varies from patient to patient. Generally older patients tend to experience more swelling than young adults and children. In the early post-operative period it is important to :
Keep the head elevated at all times, including sleeping on 3 pillows.
Use ice packs to the eyes for the first 48 hours.
Keep physical activity to a minimum
Most patients have a socially acceptable appearance by 1-2 weeks, but it takes up to six weeks for the eyelid position to stabilise.