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Ptosis surgery

Published by Bupa’s Health Information Team, August 2011.

This factsheet is for people who are having ptosis surgery, or who would like information about it.

Ptosis is a condition that affects the upper eyelid causing it to droop. Surgery to treat ptosis involves making a small cut in the eyelid and shortening the eyelid muscle. This raises the eyelid.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About ptosis surgery

The aim of surgery to treat ptosis is to lift your drooping eyelid back to its normal position. This is usually done by tightening the muscles used to raise your eyelid. If your ptosis is severe, your eyelid can be attached under your eyebrow, so that your forehead muscles can do the lifting.

Ptosis is also called blepharoptosis. In adults, ptosis develops when the muscles that lift the upper eyelid stop working properly. In babies, ptosis is caused by loose muscles in the eyelid that haven’t developed properly. This is called congenital ptosis.

Ptosis varies in severity. For example, mild ptosis may cause your eyelid to droop a small amount, which can affect your appearance but not your sight. More severe ptosis can affect the upper part of your vision and cause tiredness.

You may need surgery to treat ptosis if it’s severe or having an impact on your sight or day-to-day life. If your child has congenital ptosis, he or she is likely to need an operation to correct it.

What are the alternatives?

Ptosis doesn’t always need treating. If you, or your child, have mild ptosis, your doctor may not treat your condition, instead he or she may monitor it. This might mean regular eye tests, particularly for children.

Some people with ptosis who wear glasses choose to have them adapted with a special prop. This prop sits on the upper part of the frame of your glasses and lifts your eyelid, allowing you to see more easily. Ask your optometrist for information.

Preparing for ptosis surgery

For adults, surgery is usually done as a day case in the outpatient department, using a local anaesthetic. If you have a local anaesthetic, you will be awake during the procedure but you won’t feel any pain. If your child has surgery for ptosis, he or she will have a general anaesthetic. This means your child will be asleep during the procedure.

If your child is having a general anaesthetic he or she will be asked to follow fasting instructions. This means not allowing your child to eat or drink, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during ptosis surgery

There are several different surgical techniques that can be used to treat ptosis. The type of operation you have will depend on what your surgeon thinks is the best option for you.

Most types of surgery for ptosis involve shortening the muscles that control the movement of your upper eyelid. Your surgeon will use measurements of your eyelids to decide how much to shorten the muscle.

Local anaesthetic drops and gel are used to numb your eye and eyelid. Your surgeon will make a small cut in your eyelid, usually where the crease in your skin is. This helps to hide the scar. The muscle is shortened and then the cut is closed using dissolvable stitches.

If the muscle in your eyelid is very weak, your surgeon may need to do a sling operation called a frontalis sling or brow suspension. This is where a muscle from your forehead is used to help lift your eyelid by attaching a sling of tissue from it to your eyelid. This tissue can come from another part of your body, usually from an area just to the side of your knee. Sometimes your surgeon may use a synthetic tissue such as silicone instead.

What to expect afterwards

If you have had a local anaesthetic, you will usually be able to go home when you feel ready. If your child has had a general anaesthetic, he or she may need to rest until the affects of the anaesthetic have passed.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

After your operation, you will probably have a patch or dressing covering your eye. Keep this on for 24 to 48 hours.

Before you go home your nurse will give you advice about looking after your wound. You may also be given a date for a follow-up appointment.

As you will only have the use of one eye (the other will be covered by a dressing), you should arrange for someone to drive you home.

Recovering from ptosis surgery

Your upper eyelid may be bruised and swollen for about seven to 10 days after the operation.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Clean and dry your wound every day and check for signs of infection. These include redness, swelling, discharge and pain. Contact your GP or the hospital if you have any signs of infection.

You will be given antibiotic drops or ointment to use for one to three weeks after your operation.

It can take some time to see the full effects of the surgery on your appearance. It can be difficult for your surgeon to make your eyelids exactly the same height on both sides, though he or she will aim to make them as level as possible.

What are the risks?

As with every procedure, there are some risks associated with ptosis surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

These are the unwanted but mostly temporary effects you may get after having the procedure. After ptosis surgery you may have:

  • pain
  • bruising and swelling around your eye

Complications

Complications are when problems occur during or after your operation. Most people aren’t affected. Some of the main complications of ptosis surgery are listed below.

  • A reaction to the anaesthetic.
  • Bleeding, either during or after the operation.
  • An infection in the surgical wound or your eye, though the risk of this happening is small.
  • Over-correction or under-correction of the eyelid. This means that after the surgery your eyelid may either be too high, causing problems closing it, or not high enough. This may mean having another operation.
  • You may not be able to close your eyelid completely. This could be temporary, but in some people it’s permanent. If you’re unable to close your eye, you will need eye drops or ointment to keep it moist until the problem gets better. If the problem is permanent, you may need more surgery to correct the eyelid.
  • After surgery to one eyelid you may notice that your other eyelid also droops. This may not have been as noticeable before you had your operation.

 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: August 2011

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