Ptosis

Ptosis is the drooping of the upper eyelid. It can affect one eye (unilateral) or both eyes (bilateral). The drooping of the upper eyelid can affect your vision, as it interferes with your visual field, or obstructs your vision. You may find it difficult to keep the eye open or eyes open with ptosis.

• Difficulty in keeping your eye or eyes open

• Eye strain

• Ache around the eyebrow caused by trying to keep the drooping ptosis lid open or up

• Becoming tired when reading

• Cosmetically unappealing to some patients

• One eye looks open and the ptosis eye looks closed

• Congenital, present from birth. A defect in the levator muscle of the eyelid, the levator muscle is required to raise the eyelid. One or both eyelids could be affected. The drooping eyelid or eyelids can affect the development of normal vision; surgery may be indicated in these cases.

• Long term contact lens wearer, trauma, eye surgery can cause acquired ptosis (acquired ptosis is when ptosis occurs later in life)

• Ageing – acquired ptosis

• Injury to the eyelid – acquired ptosis

• Myasthenia gravis causing weakness in the eyelid muscle - acquired ptosis

• Myotonic dystrophy causing weakness in the eyelid muscle - acquired ptosis

• Third nerve palsy: is a paralysis of the 3rd Nerve that supplies & innovates the eyelid. This causes acquired ptosis

• Large eyelid cyst can cause acquired ptosis

• Swelling of the eyelid can cause acquired ptosis

• Marcus Gunn 'jaw-winking' ptosis, due to abnormal connections in the nerves, as the jaw is opened, the ptosis eyelid rises, as the jaw closes the eyelid droops back down

Ptosis surgery in children is done under general anaesthesia, whereas adult ptosis surgery is usually done with local anaesthetic.

• Ptosis surgery is performed to shorten or tighten the eyelid levator muscle; this stops the eyelid from drooping (stops ptosis of the eyelid).

• Another surgery that could be performed is brow suspension surgery, also know as a ‘sling’ operation, this is where tendon from your thigh or artificial tendon is used to raise the eyelid by suspending it from the brow

• A non surgical option is a ptosis crutch, this is an attachment fixed on to your glasses which holds the eyelid up

Side effects from the surgery could include:

• Overcorrection of the eyelid ptosis, this can leave you with an eyelid that sits too high. Further treatment may be required to help lower the eyelid

• Lid lag, where the lid does not move down when you look down

• Dry eyes due to poor eyelid closure

• Lagophthalmos, the inability to close the eye

• You may experience bruising of the eyelids and face after surgery

• Less common is bleeding and infections

• Eyelids of both eyes may not look symmetrical