Ptosis

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Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid(s). The drooping of the upper eyelids may cause a obstruction of vision. A droopy eyelid may cause difficulty keeping the eye open. To compensate , people with ptosis strain their forehead muscles, to keep their eyes open. In severe cases, a person with a ptosis will use their fingers to lift up their eyelid.

Children with a droopy eyelid may develop a lazy eye, because the droopy eyelid obstructs the line of sight. If a lazy eye starts to develop, then the ptosis needs to be fixed up to prevent a permanent lazy eye.

What Causes Ptosis?
There are many causes of ptosis including :
age related weakening of the muscle
congenital weakness ( develops at birth)
trauma
neurologic disease

Age related weakness occurs as a result of stretching of the muscle that lifts up the eyelid. This represents the most common cause of a droopy eyelid. Ptosis may also occur following routine eye surgery due to stretching of the muscle or tendon. Children may be born with ptosis or may acquire it due to trauma or neurologic reasons.

What are the signs and symptoms of adult blepharoptosis?

A drooping eyelid is the primary sign of blepharoptosis. There may be some vision loss in the upper field of vision. There may be fatigue from attempting to elevate the lid or there may be a compensatory elevation of the brow. Droopy eyelids can also have a profound effect on a person’s cosmetic appearance and self-esteem as they often cause a person to appear sleepy or cause asymmetry to the face.

Blepharoptosis Surgery

You will visit the clinic to have a preoperative consultation with your surgeon. This usually lasts 30-45 minutes. You will be asked about:

Your specific expectations
Your current and past general health
Any previous eye, eyelid or facial surgery or treatments including refractive surgery or laser eye surgery
Any past dermatology history e.g. cold sores, eczema, rosacea, skin cancer
Any history of a dry eye problem
Any contact lens wear
Any previous non-surgical aesthetic treatments e.g. Botox injections, dermal fillers injections
Any allergies
Any medications you take (including over the counter products e.g. Aspirin, Indomethacin, Nurofen, Diclofenac or vitamin supplements)
Any history of smoking
It is very helpful if you have old photographs which you can bring along to the consultation.
If you are happy to email us digital photographs of your current appearance in advance of the consultation with details of your concerns, this is also enormously helpful and saves time. Your photographs will be kept confidential and will form part of your clinical record.

The assistants are also happy to answer any further questions and to show you the facilities at icaresandton including the operating theatre if it is not in use.
Please answer all questions completely and honestly as they are asked only for your own well-being, so that your surgery can be planned as carefully as possible. The information is treated confidentially. If you are unsure of the names of any medications, bring them with you.
Your blood pressure should also be under good control if you take medications for hypertension. This is very important.

Your vision is measured. Your eyes are examined carefully using a special ophthalmic microscope. Your tear film status is determined and the back of the eyes (called the retina) are examined as well as the eyelids themselves.

The rest of your face is then examined. Photographs of your face and eyelids are taken before surgery so that the results of surgery can be compared with the original appearance. The photographs are confidential and can only be used for any purpose other than your own records with your specific written permission.

For patients who are on medical aid a formal visual field record and photographs are often required by your medical aid company. These are taken at the time of consultation and provided to your medical aid provider so that authorization for your surgery can be obtained.

What happens after blepharoptosis surgery?

After blepharoptosis surgery, the eyes are initially covered with pressure dressings for approximately half an hour to reduce postoperative swelling and the wounds are treated with antibiotic ointment. The dressings are then removed and replaced with cool packs. Activity is restricted for 2 weeks to prevent bleeding.

You will be asked to clean the eyelids very gently using clean cotton wool and sterile saline or cooled boiled water and repeat the application of antibiotics to the wounds 3 times a day for 2 weeks. The sutures used for a levator aponeurosis advancement are dissolvable but are usually removed in clinic after 2 weeks.

The skin around the eyes should be protected from direct sunlight, by avoidance if possible or by using protective sunglasses. Wearing make-up should be avoided for at least 2 weeks. It is important to devote a lot of time to your aftercare for the first 2 weeks and some patients find this somewhat labour intensive.

A realistic period of recovery must be expected. Postoperative bruising usually takes at least 2-3 weeks to subside completely. Swelling takes much longer. Most of the swelling disappears after 3-4 weeks but this can vary considerably from patient to patient as does the extent of the swelling. The final result is not seen for at least 3-4 months. This should be taken into consideration when scheduling the operation. You should arrange this surgery after holiday periods or important professional or social events and not before so that you are available for postoperative review and just in case any surgical adjustments are required.

The scars gradually fade to fine white marks within a few months. Those in the upper eyelid are hidden within the skin crease.

You will need to use frequent artificial tears for the first 2-3 weeks following surgery. It is preferable to use preservative free drops. These will be prescribed for you.

Contact lenses should not be worn for a few weeks following this type of surgery.

Can Ptosis Be Corrected?
Ptosis can be corrected surgically and usually involves tightening the muscle that elevates the eyelid. In severe ptosis, when the levator muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s).

Your ophthalmologist will perform tests and measurements on the eyelid, in order to accurately treat the ptosis.The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid. Who Should Perform Ptosis Surgery? When choosing a surgeon to perform ptosis surgery, look for a cosmetic and reconstructive facial surgeon who specializes in the eyelids, orbit, and tear drain system.

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