What is ptosis surgery?

Ptosis, also known as droopy eyelid, is a condition where the upper eyelid droops over the eye. This can affect one or both eyes and can range from mild to severe. Ptosis surgery is often recommended to correct this condition, improving both vision and appearance.

Here, Miss Anuradha Jayaprakasam, renowned consultant ophthalmologist and oculoplastic surgeon, provides comprehensive information about ptosis surgery.

When is ptosis surgery recommended?

Ptosis surgery is recommended in several scenarios to address both functional and cosmetic concerns. Here are the primary situations where ptosis surgery might be advised:

• Impaired vision: The most significant reason for ptosis surgery is when the drooping eyelid interferes with vision. This is particularly crucial if the drooping eyelid obstructs the pupil.
• Aesthetic concerns: Many patients opt for ptosis surgery due to cosmetic reasons. A drooping eyelid can make one appear tired and aged, affecting self-confidence and emotional wellbeing.
• Physical discomfort: Ptosis can sometimes cause physical discomfort, such as eye strain or headaches from trying to lift the eyelid.
• Congenital ptosis: In children, ptosis can interfere with normal vision development, leading to the development of amblyopia (lazy eye) and strabismus (crossed eyes).
• Age-related ptosis: Age-related ptosis occurs due to the natural weakening of the levator muscle or the stretching of the eyelid’s skin and connective tissues.

What can I expect during the initial consultation for ptosis surgery?

The initial consultation is a crucial step in the process for ptosis surgery.

The specialist will first review the patient’s medical history, including any previous eye surgeries, medical conditions, and medications being taken. The patient will discuss their symptoms, how the ptosis affects their daily life, and the goals for the surgery.

Subsequently, a comprehensive eye examination will be conducted to assess the extent of the ptosis and its impact on the patient’s vision. This may include visual field tests to measure the degree of vision obstruction.

The specialist will then explain the surgical procedure, including the techniques that will be used, what to expect during and after the surgery, and the potential risks and benefits. Pre-operative photographs of the patient’s eyelids will be taken to document their condition and help in planning the surgery.

Patient consent will be obtained, and pre-operative instructions will be provided on how to prepare for the surgery, including any necessary tests, medications to avoid, and guidelines for the day of the surgery.

How is ptosis surgery performed?

Ptosis surgery involves the correction of a drooping upper eyelid by tightening the muscles responsible for lifting the eyelid. This surgery can be performed under local anaesthesia with sedation or under general anaesthesia, depending on the patient's needs.

During ptosis surgery, the specialist will make an incision in the natural crease of the upper eyelid to minimise visible scarring. In some cases, particularly with less severe ptosis, the incision may be made on the underside of the eyelid (transconjunctival approach).

Depending on the severity of the ptosis and the underlying cause, different techniques will be used to adjust the muscles:

Levator resection or advancement

• Levator resection: The levator muscle, which is responsible for lifting the eyelid, is shortened. This involves removing a portion of the muscle and reattaching it to achieve the desired lift.
• Levator advancement: In this technique, the levator muscle is not shortened but repositioned or advanced to a higher location, providing better eyelid elevation.

Müller’s muscle-conjunctival resection (MMCR)

• Müller’s muscle resection: For patients with mild ptosis, the specialist may perform a resection of Müller’s muscle, which is a secondary muscle contributing to eyelid elevation. This is done through an incision on the underside of the eyelid.
• Conjunctival approach: This method involves resecting a portion of the conjunctiva (the mucous membrane covering the front of the eye and the inside of the eyelids) along with Müller’s muscle.

If there is excess skin on the eyelid, it will be removed during the procedure to ensure a smooth and natural appearance. This step is more common in patients with significant skin laxity due to ageing.

Lastly, the specialist will close the incision with fine sutures, which are usually removed within a week after the surgery. The use of fine sutures will help to minimise scarring and promote faster healing.

The patient will be monitored for a short period in the recovery area before being discharged. They will receive instructions on how to care for the surgical site, manage any discomfort, and take any prescribed medications.

What are the risks and potential complications involved with ptosis surgery?

Like any surgical procedure, ptosis surgery carries potential risks and complications, including:

• infection
• bleeding and bruising
• temporary dryness or irritation of the eyes 
• difficulty fully closing the eye after the surgery

It’s important for patients to discuss these risks with the specialist during the initial consultation to understand how these apply to their specific situation.

What is the recovery period like after ptosis surgery?

The recovery process after ptosis surgery is generally straightforward, but it requires careful adherence to post-operative instructions to ensure optimal healing and results.

For the first 24 hours after the surgery, patients should rest with their head elevated to reduce swelling. Ice packs should be applied to the operated area for 10-15 minutes at a time to minimise the swelling and discomfort. After 24 hours, patients should use prescribed eye drops and ointments to prevent infection and keep the eye lubricated.

Most patients will return to work and normal activities within 1-2 weeks but full recovery, including the resolution of swelling and bruising, will take longer. Patients should avoid rubbing their eyes, avoid using contact lenses, and avoid exposing their eyes to smoke or dust during the whole recovery period.

When will I see the final results of ptosis surgery?

Patients will see an initial improvement in the position of their eyelid immediately after the surgery, but swelling and bruising will obscure the final results. Full maturation of the surgical results, including the settling of the eyelid position and the healing of any incisions, may take up to 6 months as the healing process continues and any residual swelling and bruising resolves.

Ptosis surgery can significantly improve both the functional and aesthetic aspects of droopy eyelids, but it’s important to have realistic expectations and to follow the specialist’s post-operative instructions carefully to achieve the best possible outcome.

If you would like to schedule an appointment with Miss Anuradha Jayaprakasam, head on over to her Top Doctors profile today.