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Ptosis (pronounced Toe-sis) is more commonly known as drooping eyelids. The upper eyelid droops over the eye in some cases blocking the upper field of vision. It can also detract from the person's appearance, and give a 'sleepy' appearance. Ptosis can be acquired, typically as a person ages or can be present from birth where the cause is often the lack of development of the levator muscle. Ptosis surgery in adults is often combined with blepharoplasty and brow lift procedures.
It is important to determine the specific cause of ptosis as it will determine the treatment. For example, if ptosis is the result of muscle, tumour or nerve disease, the disease will need to be treated or the tumour removed first. A full eye examination will be required and occasionally blood samples reviewed before a diagnosis is made.
Where surgery is required (particularly in cases present since birth) the procedure usually involves either shortening the levator muscle or attaching it to the muscles of the brow restoring the eyelid to its normal position. The shortening procedure is normally performed under local anaesthetic as it is easier to take a more accurate assessment of the height of the lid at the time of surgery. Occasionally, the lid is raised by suspending it from the brow. This is done using manufactured material or with tissue which is taken from the leg through a small skin incision above the knee. Surgery is often performed on both eyes in these cases, in order to achieve a better, more symmetric, cosmetic result.
It is difficult to predict the results of the surgery. Approximately 95% of patients are satisfactorily corrected with the first operation with an experienced oculoplastic surgeon. The remaining 5% require a further procedure to correct such problems as the eyelid being too low, the eyelid being too high, the curve being irregular or the skin crease being defective.
Complications with this procedure, assuming surgery is carried out by an appropriately qualified oculoplastic surgeon and the patient has followed the medical advice given are infrequent and usually minor. However, all surgery carries a risk, the complications that can occur include infection and/or dry eyes, over or undercorrection, asymmetry of the eyelids, and bleeding/bruising. If an infection develops it is important it is treated quickly as it may affect the results of the surgery if left untreated.
Your complete medical history will be required, so check your own records ahead of time and be ready to provide this information. Be sure to inform us if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.
In this consultation, a full eye examination will be performed and blood tests may be taken. You should also provide any relevant information from your optician or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along. You should carefully discuss your goals and expectations for this surgery. If tissue is to be taken from the knee a firm dressing will be applied after the operation, which will usually be removed at the first outpatient appointment. There will be a stitch in the leg which is removed after about ten days. This may be done by your own GP if you prefer. You will need to follow any guidelines on how to prepare for surgery, including eating, drinking, smoking and taking or avoiding certain vitamins and medications. You may need to arrange for someone to drive you home after surgery and be around to help you out at home if needed for a few days.
Following the procedure, you will be given some antibiotic and lubricant drops to put in your eye, and some ointment for night time. It is essential that you use these, as these drops will help to prevent drying of the surface of the eye and the occurrence of an infection. Once home, you should avoid bathing for 2-10 days, but may wash or shower. Swimming is not allowed for at least 2 weeks, and longer if the eye is still red. If you play football, you must not 'head' the ball for 6 months if you have had an operation joining the lid to the eyebrow.