Ptosis Surgery

Ptosis can be present from birth or develop later in life.

• From birth (congenital ptosis): usually because the muscle that lifts the eyelid has not developed fully.
• Age-related: the tendon that attaches the lifting muscle to the eyelid stretches or thins. This is the most common type in adults.
• Other causes include long-term contact lens wear, injury, previous eye surgery and, less often, nerve or muscle conditions such as myasthenia gravis or a third nerve palsy.

In a child, a drooping lid that covers part of the pupil can affect how vision develops and lead to a lazy eye (amblyopia). It should be checked early.

• Measuring how far the eyelid covers the eye, and how strong the lifting muscle is.
• Checking the field of vision and whether the surface of the eye is dry.
• Looking for an underlying cause. Occasionally blood tests or a scan are needed.
• For children, a vision and glasses assessment.

The type of operation depends mainly on how well the lifting muscle works.

• Reasonable muscle function: the muscle or its tendon is tightened or shortened (LPS plication, advancement or resection), usually through a cut hidden in the eyelid crease. Mild ptosis can sometimes be corrected from the inside of the eyelid.
• Poor muscle function: a sling (tarso-frontal or frontalis sling) connects the eyelid to the forehead muscle, so that raising the eyebrow lifts the lid.

• Adults: usually under local anaesthetic, going home the same day. Each eye takes roughly 45 minutes to an hour.
• Being awake allows the surgeon to check the eyelid height during the operation.
• Children: under general anaesthetic, usually as a day case.

• Cold compresses help with swelling and bruising, which usually settle over 10 to 14 days.
• Ointment or lubricating drops may be prescribed, because the eye can feel dry while the lid settles.
• Stitches are usually removed or checked at about one week.
• The height and shape of the eyelid can keep changing for about three months before the final position is judged.
• Children usually go back to school after 7 to 10 days, and avoid contact sports and swimming for a few weeks.

Every operation carries some risk. Your doctor will go through the risks that apply to you before you decide.

• The eyelid may end up slightly too high or too low, or the two sides may not match exactly. A further adjustment is sometimes needed.
• Difficulty closing the eye fully, with dryness, particularly in the first weeks.
• Bruising, bleeding or infection.
• After sling surgery in children, the sling occasionally has to be removed or replaced, and the eyelid may lag when looking down.
• Loss of vision from bleeding is very rare.