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Ptosis Repair

Introduction

What is ptosis?

Ptosis is true drooping of the upper eyelid due to weakness of the eyelid (levator) muscle. Some patients think they have a cosmetic problem when they actually have a functional problem such as ptosis. Weakness and stretching of the upper eyelid muscle cause the lid margin to sit at a lower than normal level, often producing a ‘sleepy’ look. When severe, the pupil can be partially or totally covered and obstruct vision. As the muscle is now sitting higher than it should be, it tends to give people a hollowed appearance in the upper lid, and the eyebrows elevate to compensate for the weakened muscle. Reattachment of the muscle will lift the lid, fill in the hollow, and allow the brow to relax to its normal position.

Procedure

Ptosis repair is performed under local anaesthetic, with or without sedation, as a day procedure. An incision in the lid is made with a CO2 laser. Excess skin and fat is then removed and the levator muscle is exposed. The detached muscle is then reattached to its normal position with absorbable sutures and the skin is then sutured. These skin sutures will be removed approximately six days later. Both upper lids usually require surgery at the same time to assure symmetry.

Postoperative Instructions

(Instructions after eyelid surgery)

  1. No bending, lifting heavy objects or any strenuous exercises for ten days.
  2. Swelling is to be expected and can vary from mild to severe.  For the first two days, frequent use of a cold compress is recommended.  Take a clean bowl of cold water, add a clean facecloth, soak it in the cold water and squeeze it out.  Place the facecloth over the incision site.  When the cloth is no longer cool, rinse it again in the cold water.  A cold compress will reduce swelling and discomfort.
  3. Do not use frozen peas, Cryo‑Gel™ Gel Packs etc. Use ONLY light cloths similar to what is supplied in theatre.
  4. When lying down, use two to three pillows.  During the day, it is best to keep moderately active.  Lying down during the day will increase the swelling.
  5. You may take Paracetamol tablets if necessary for pain. If your Doctor has prescribed Aspirin, you should continue taking it as prescribed.
  6. A small amount of blood ooze is normal during the 24 hours following surgery.  If bleeding is excessive, phone Dr Lamb.
  7. Use antibiotic ointment as prescribed by Dr Lamb on skin wounds four times per day until sutures are removed. 
  8. Use antibiotic drops to eyes four times per day until instructed by either Dr Lamb or our R.N at time of suture removal. (Only required if surgery to Lower Lids has been performed).
  9. Take oral antibiotics 4 times a day until finished. (if prescribed).

Showering and hair washing as normal.

Risks

This procedure involves incisions using laser on the outer surface of the upper lids the muscle that lifts the lid can then be repaired. At the same time cosmetic blepharoplasty to remove excess skin and fat can be performed. Complications can occur, but are rare.

Infection is always a possibility – however this is rare after lid surgery.

Haemorrhage can occur and has the potential to affect eyesight, however this is very rare.

Ptosis present from an early age is difficult and often requires more than one surgery to be satisfactory complete symmetry is not guaranteed. 

As the upper lid skin is incised and sutured a scar may result.  The incision is in the lid crease and will fade with time. Lid asymmetry can occur and may require modification.

The laser can damage the eye if fired directly at it.  This should not occur as Dr Lamb uses specially designed eye shields to prevent this.

Some discomfort, swelling and possibly bruising can occur, however it is minimised by the use of laser.

The level of the lid may be too low or too high and may require time to stabilise and can require further surgery.

Combining Ptosis Repair with other procedures

When repairing the levator muscle, Dr Lamb may also perform a Cosmetic Blepharoplasty if excess skin or fat is present. In other words, all Dr Lamb’s functional patients will have a successful cosmetic result. As ptosis is medical, the surgery will attract a benefit from your private health insurance and Medicare. Dr Lamb does not charge for this cosmetic component of ptosis surgery.

Ptosis is under-diagnosed by health professionals to the point that it is almost considered a normal appearance for older people. In children, ptosis can either be congenital or acquired due to injury or illness, Dr Lamb refers these cases to a paediatric ophthalmologist.