When one or both of your eyelids droop over the pupil margin you are likely experiencing Ptosis of the eyelid, or simply called Ptosis (toh-sis) When the droop is minimal it simply gives the appearance of being sleepy but can be more noticeable if it affects one eye more than the other. However, if ptosis is more pronounced it can interfere with your vision as the eyelid will partially or totally cover the pupil of your eye and not allow light to enter. Both children and adults may have ptosis. Our physicians do surgery to correct ptosis in patients of all ages.
Symptoms of Ptosis:
Ptosis may occur along with other eye problems and can cause other eye problems. For example, when a very young child has congenital ptosis, visual development may be impaired if the vision is blocked. This can lead to a “lazy eye” or amblyopia, a permanent loss of vision that is difficult to correct at later ages. Repairing ptosis in such cases is important for the normal development of a child’s vision.
When ptosis develops in later life it is called involutional ptosis. The muscle that raises the eyelid (levator muscle) stretches or even separates from the eyelid. This can be caused by an injury but also just happens as a person’sage. In addition, other eye diseases or eye surgery may be the cause.
A complete eye exam will be done to find the cause of your ptosis, rule out any other systemic causes, and recommend the appropriate treatment. The definitive therapy for ptosis is generally surgery to tighten up the levator muscle.
When ptosis surgery is done, the incision is made in the eyelid skin crease which hides the incision. The weak muscle is identified and tightened up using stitches that will remain permanently. Because the tightened muscle is less flexible than before the surgery, it is common that closing the eye may be difficult for several weeks after surgery. Thus, your surgeon may prescribe medication to keep the eye moist during this period. In addition, they will insert punctal plugs into the tear ducts of the eye. This keeps tears from draining into the duct to help keep the eye moist. The sutures along the skin crease do not dissolve by themselves and will be removed at your follow-up appointment. Sometimes lifting one eyelid will cause the other one to droop, if this happens you may need a touch-up surgery.
These are some of the questions that our Calgary ptosis patients often ask along with our answers.
Ptosis is a medical term for when the upper eyelids droop sufficiently to cover part of the pupil of the eye and thus obstruct vision. This condition is usually due to ageing but can be caused by trauma, prior eyelid surgery, or even contact lens use. Ptosis is treated by tightening up the muscle that raises the eyelid.
Your ptosis repair surgery is done with local anesthesia with extra sedation by an anaesthesiologist as required. This is an outpatient surgery. The incision is made along a crease in the eyelid or if possible, invert that lid and make the incision on the inside. In either case, this hides the incision. The weak muscle is identified, and a suture is used to tighten it sufficiently to relieve the ptosis. Because the eye may not close well for several weeks after surgery, plugs are inserted into the tear ducts (punctal plugs) to help keep the eye moist. Although the stitches in the skin need to be removed two weeks after surgery the deeper stitches supporting the muscle will remain in place permanently.
These are tiny plugs that are inserted into the openings of the tear ducts, the lacrimal puncta. There are two of these little drains on the inner aspect of both eyes. Either the upper or lower puncta may have plugs placed or both. These plugs are meant to stay in place and help keep the eye moist for the time it will take for the eyelid to close normally. Plugs that dissolve on their own can be used or ones that can be easily removed in the office. These plugs do not affect your vision, are not noticeable, and don’t cause any irritation.
You will need to bring a driver with you for after your surgery as you will not be able to drive home after your surgery or for the next fifteen days. The eye is not affected by this surgery but local swelling and the antibiotic ointment you are using may make it difficult to see well for a few days.
You will receive all the information you need for incision care and taking care of the surgery site. This list of instructions will also include times for your follow up visits with the doctor. You will also receive any necessary prescriptions at this time.
Problems and complications after ptosis are unusual but include scarring, recurrent or persistence of the ptosis, infection, poor closure of the eyelid, temporary or permanent numbness, asymmetry of the eyelids, dry eyes, or visual loss.
Swelling and bruising are normal after ptosis surgery and go away with time. We recommend that you do not have this surgery within a month of important events like a wedding, as there can be bruising and swelling for several weeks. Because the antibiotic ointment you will be using may impair your vision for a few days we strongly recommend that you not work with power tools or any equipment where you need perfect depth perception until any blurring of your eyes has resolved.
Dr. Karim Punja, an Ophthalmologist at the Calgary Orbit Eye Centre, specializes in oculoplastic surgery and cosmetic and reconstructive eyelid surgery. He has extensive experience in blepharoplasty (droopy eyelids), Botox & fillers, lacrimal & orbital surgery, and cataract surgery.
Dr. Chirag Shah is a comprehensive Ophthalmologist in Calgary and retinal medical specialist. His practice areas focus on retinal diseases, including age-related macular degeneration (AMD), retinal detachments, retinopathy of prematurity (blinding retinal disease in premature babies), diabetic retinopathy, hereditary eye diseases, and hypertensive retinopathy.
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