Ptosis is an inability to open your eyes as wide as considered normal.
People can be born with ptosis, although more commonly it develops in later life. This can be due to either a familial trait, contact lens use or rarely more concerning causes. It is not to be confused with dermatochalasis (eye bags) which is an excess of upper eyelid skin, which is corrected by a blepharoplasty.
I personally perform over 60 ptosis corrections every year and supervise many others during my NHS work.
What are the risks?
- under-correction (persistent droopy eyelid)
- asymmetry of height and contour of eyelid margin or of skin fold
- dry eye, requiring the use of artificial tear drops
- temporarily blurred vision
- weak or limited eyelid closure (especially at night)
- failure or recurrence
- possible need for another ptosis repair in the future
- cysts or whiteheads along suture sites
- temporary patches of numbness of the eyelids
- orbital haemorrhage with a potential for permanent visual loss.
In addition to the risks specific to the individual procedure, there are also general risks, such as blood loss, infection, cardiac arrest, airway problems and blood clots, which are associated with any surgical procedure. Local anaesthetic may cause bruising or possible allergic responses. If your operation is to be carried out under general anaesthetic, the anaesthetist will discuss this with you.
What are the benefits?
- Correction of ptosis (droopy eyelid)
- Improvement of symmetry of eyelid height and contour
- Improvement to visual fields (peripheral and above)
- Where excess skin is also present, skin removal (blepharoplasty) may also be performed.
What are the alternatives?
Surgery is generally the best treatment for ptosis. If, however, you choose not to proceed with surgery, the droopy eyelids will persist and may worsen with time but will not have any permanent detrimental effect on your vision or general health. Ptosis props are devices attached to spectacles that can hold the eyelids up but many people find them uncomfortable or ineffective.
My book chapter: Chapter 64 – Conjunctival Approach Levator Surgery. 2014. In: Spaeth G and Yanoff M (eds). Expert Techniques in Ophthalmic Surgery. Philadelphia: JP Brothers Medical.
For further information visit the British Oculoplastic Surgery Society website: www.bopss.co.uk