Droopy Eyelids (ptosis)
What is a ptosis?
Ptosis, or drooping of the upper eyelid, can happen in one or both eyes. Ptosis can interfere with vision by affecting the upper field of vision. It may also cause eye strain, eyebrow ache or cosmetic concerns.
What causes my condition?
Ptosis can sometimes be present at birth; this is known as congenital ptosis and is usually due to a defect in the upper eyelid muscle. However, more commonly it appears later in life, as an acquired ptosis. This can be the result of long-term contact lens wear, trauma or following other eye surgery, which can all cause stretching of the upper eyelid tendon. Sometimes this stretching is just caused by age-related changes in the eyelid.
There are a few other rare causes of ptosis which include other conditions that can weaken the eyelid muscles, such as myasthenia gravis or myotonic dystrophy, or which cause paralysis of the nerves supplying the eyelid.
What is ptosis surgery?
This is surgery to lift one or both of your upper lids. It is usually performed under local anaesthetic, although occasionally some sedation can be given during the procedure to help you to relax. If you feel you will require sedation, please discuss this in the clinic, as it needs to be planned.
You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution and sterile cloth will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds.
The surgery should take approximately 45 minutes per eye. You may feel some light tugging on your eyelid during the surgery and you may also be asked to look up and down. At the end of the surgery, the skin wounds are closed with sutures (stitches), ointment is applied and a pressure dressing is placed over the eyelids. If you have both eyes done then one of the eye pads will be removed after about an hour.
What are the benefits?
Ptosis surgery can improve your field of view and brighten your vision. It can also relieve eye strain and brow ache or headache if these are caused by the eyelid droop. It should improve the symmetry of your eyes.
What are the risks?
Ptosis surgery is generally successful, with eight out of ten lids being in a good position after surgery. However, as with any surgery, there are some risks associated with it which include the following:
Bruising and swelling is common and may persist for a few weeks after surgery.
Infection in the wound is possible.
As the eye is being opened up more, it may be harder to close it after surgery. Your eye may feel dry and gritty and you may have to use artificial tear supplements for few months.
The surgery is not absolutely precise due to the number of factors that can affect the final lid height. Under correction or over correction is therefore possible which may need re- evaluation and more procedures.
Bleeding into deep tissue can lead to disturbance of vision and could lead to loss of vision in severe cases. This is extremely rare, and you should report any loss of vision to the hospital immediately.
How can I prepare for the treatment?
You will be assessed in the clinic and can discuss the proposed surgery in detail with your eye surgeon. You will have a pre-operative assessment with a nurse where more information will be provided. If you are taking any medicines that thin your blood, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for examples warfarin or rivaroxaban), please tell your doctor or the nurse as you may need to stop them temporarily before yoursurgery. Also tell your doctor or nurse if you have diabetes as you may need to alter the dose of your diabetes medicines, as you will need to fast before the procedure. Further information on stopping any medicines will be given to you when you come for pre-assessment.
Surgery under local anaesthetic
If you are having the surgery under local anaesthetic, you can eat as normal before the treatment but you should only have a light meal. Please wear comfortable and loose-fitting clothing on the day of surgery. You may need to organise a responsible adult who can assist you on your way home. They may also need to stay with you for at least one day after the treatment.
Consent - asking for your consent
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.
Remember that you may need to bring your reading glasses into the hospital with you to help you read the form. If your sight is poor you can ask the doctor or a relative to read it to you and check it before you sign.
If you would like more information about our consent process, please speak to a member of staff caring for you.
Will I feel any pain?
Anaesthetic is injected under the eyelid skin, which causes a sharp and stinging sensation for few seconds. Following this, you should not feel any pain, although you might be aware of some pulling sensations. Your eye may be slightly painful for about for 24 – 48 hours after the surgery and you can take paracetamol regularly to help with this.
What do I need to do after I go home?
You will be given some antibiotic ointment or drops and some lubricating eye drops. This is to minimise the risk of infection, and reduce dryness in the eye. It is important to wash your hands before using these, to reduce the chance of any wound infections.Your vision may be blurred for few days after surgery and you may not be able to wear contact lenses. If your eye gets more painful, your vision gets worse, your eye becomes more red or you notice excess discharge from your eye, your should come back to the nearest Eye casualty department immediately.
You may want to take few days leave from work depending on your individual circumstances. You should not resume any strenuous activity, including swimming, for two weeks after surgery. It is best that someone stays with you to help you for at least a day after the treatment.
You are advised not to drive, operate machinery, drink alcohol or take sedative drugs for 24 hours.
Will I have a follow-up appointment?
When you leave after your surgery, you will be given an appointment for the outpatient clinic for one to two weeks afterwards.