Ptosis can cause problems with your vision and leave you feeling unhappy with your appearance. Surgery aims to resolve these issues. Here we discuss what ptosis is, its symptoms and treatment options.
What is ptosis?
Ptosis is the upper eyelid drooping of one or both eyes. Your eyelid may only droop a little, or it may droop low enough to cover the pupil and affect your vision. If you have ptosis, you may struggle to keep your eyelids open, experience eyebrow aches, and have eyestrain or fatigue.
Children with congenital ptosis are born with the condition. They may tilt their heads back or arch their eyebrows to help them see better, leading to neck pain and headaches. Your child may also wink when they open their mouth if they have Marcus Gunn jaw-winking ptosis.
Causes in adults (involutional or acquired ptosis) include:
- An eye injury
- Weak eyelid muscles
- Long-term contact lens wear
- Paralysed nerves leading to the eyelid
- A thin, stretched or separated levator muscle
In rare cases, a tumour or a neurological condition, such as myasthenia gravis, can cause it. We may recommend blood tests or an MRI scan if we suspect these.
Treatment options for ptosis
If the eyelid droops slightly (mild ptosis), some people explore treatment options without surgery. You may wish to monitor it or see an eye specialist for further advice. You could also use a ptosis prop, or crutch, to hold your eyelid in place if you wear glasses. However, these can affect your ability to blink and may cause dry eyes. We may recommend a ptosis prop or eyedrops as a temporary option for adults and children.
You may consider a non-surgical or surgical procedure if your droopy eyelid affects your vision (moderate to severe ptosis). Non-surgical procedures include Botulinum toxin (BoNT), for example, Botox®, dermal fillers, and laser treatments. These can lift your brow or tighten the surrounding skin to improve vision loss from ptosis.
Ptosis repair surgery involves correcting the length of your eyelid’s muscles or tendons to raise it. It is a functional medical procedure, meaning you need it to help you see better. We may combine this with a cosmetic procedure, such as blepharoplasty or a brow lift, to enhance the appearance of your eyes after the procedure.
Ptosis repair surgery
Before the procedure, we will numb your eyes and the surrounding area with a local anaesthetic to prevent pain. If your child is having the surgery, we will use a general anaesthetic to send them to sleep. It takes around 45 minutes per eye to complete ptosis surgery. There are two approaches to this procedure: external or internal repair.
During an external repair, also known as levator advancement, we make a small cut on the crease of your upper eyelid. We can then reposition the levator muscle and stitch it to the eyelid. This approach is the most common surgical treatment for ptosis. We may recommend it if you have good levator muscle function and moderate or severe ptosis.
This approach involves accessing the eyelid internally by turning it inside out. We then shorten the muller’s or levator muscle, depending on how much of the eyelid we need to lift. You may be more suitable for an internal repair if you have strong or adequate levator muscle function and mild ptosis.
In severe cases, we may perform brow suspension surgery to attach the frontalis (a muscle in your forehead) to the eyelid. Other names for this treatment include frontalis sling surgery and frontalis suspension (FS). This procedure allows your forehead muscle to elevate your eyelid. We often do this to treat congenital ptosis. You may struggle to shut your eye entirely as you recover, but this is typically temporary, and we will provide you with lubricating eye drops if this happens.
Unless you’ve had general anaesthesia, you can go home a few hours after the procedure. You should arrange a lift home as you may need to wear an eye patch or pressure dressing overnight to prevent bruising or swelling.
Keep your eyes clean and dry them carefully while they heal. We may give you an antibiotic ointment and lubricating eye drops to prevent infection and help your eyes recover. You may need to use these for two weeks, but our specialist will provide specific advice on looking after your eyes.
Side effects and risks
As with any procedure, you can expect some short-term side effects. Your eye may bruise or feel sore for around ten days. Avoid strenuous physical activity, swimming, rubbing your eyes, and wearing eye makeup during this time.
The antibiotic ointment that we provide may cause minor blurry vision, which can affect your driving. Do not drive if your sight is affected.
Risks of this procedure include over-correction and under-correction, meaning the eyelid is too high or low. However, this is less likely if we use local anaesthesia, which allows us to judge the position of your eyelid better. Other risks include incomplete eyelid closure, dry eyes, infection, and a skin scar if we use an external approach.
How much does ptosis surgery cost?
The cost of ptosis surgery depends on which procedure you need and other factors, such as the complexity of your case. At Oculase, prices start from £3,500 per eye. Book a consultation with our specialist, Dr Daniele Lorenzano, to discuss your treatment options further.
Why visit Oculase for private treatment?
You may wish to get this procedure privately if the NHS has said you are not eligible. The NHS may say you are ineligible if your condition does not impact your vision to a certain extent.
With private treatment, you don’t need to meet this threshold. We can also perform cosmetic surgery simultaneously to improve the appearance of your eyes and help you feel happier with how you look. Additional benefits include faster waiting times and easier access to your specialist for personalised advice.
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