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Everything you need to know
Ptosis refers to the drooping of the upper eyelid, which can partially or completely cover the eye. This condition can occur due to various reasons, including muscle weakness, nerve damage, or a congenital (present at birth) issue. Ptosis can affect one or both eyes and may lead to visual obstruction if severe. Treatment options depend on the underlying cause and may include surgery to correct the position of the eyelid.
Ptosis can result in:
- Finding it difficult to keep your eyelids open
- Eye fatigue, especially when reading
- Strained eyes
- Eyebrow ache
Rarely, the problem is present from birth (congenital) and is usually due to a poorly developed eyelid lifting muscle. Many cases are age-related, so the droopiness can gradually worsen as time goes on. Other causes include long-term contact lens wear, trauma and, rarely, tumour or neurological problems.
Mild ptosis may not need treatment or could be treated non-surgically. However, if your ptosis is interfering with your vision, your surgeon may recommend ptosis correction.
As the cause of ptosis can vary among individuals, a comprehensive examination by an eye specialist is necessary to determine the underlying reason for the drooping eyelid.
Before
Consultation
Firstly, you will need to book a consultation with one of our oculoplastic surgeons. Your doctor will also ask you about your symptoms and medical history, including whether Ptosis or other muscle diseases run in your family.
They will then conduct a comprehensive examination of your eyes to assess various factors, such as the condition of your eyes, eyelids, skin, eyelid laxity, and the presence of conditions like blepharitis or dry eyes, which could impact any surgery. Where anything abnormal is found, you may be referred for some scans, such as CT or MRI scans.
If you are found to have muscle weakness, the doctor may also recommend having a blood test to determine whether you have Myasthenia Gravis. This is a rare condition that affects how the muscles respond to nerve messages.
If ptosis correction is recommended, they will thoroughly explain the surgical procedure to you. The discussion will cover expected outcomes, potential risks and benefits, as well as the necessary pre- and post-operative care. Photographs will be taken for comparison post-surgery, and it’s beneficial if you bring any previous facial photos for surgical planning. A detailed medical history, including information about medications, allergies, past surgeries, and lifestyle habits (such as smoking), will be collected.
Pre-Assessment
If you decide to have surgery, you will have a call with our pre-assessment team, where they will check your fitness for surgery and talk you through the procedure. This is a standard check to make sure you are safe to go ahead with surgery.
If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Surgery day
Eyelid ptosis correction surgery is a day-patient procedure, which means you can be treated and go home the same day. It is performed under local anaesthetic, so you will be awake but will feel no pain.
On the morning of surgery, do not wear any facial make-up or contact lenses, wear loose, comfortable clothes and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications.
Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.
Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.
During
Surgery for eyelid ptosis involves shortening the muscles or tendons that raise the lid. Different methods, such as levator (the muscle that lifts your upper eyelid) resection, can be used. The choice of technique depends on factors like the type and extent of ptosis, the strength of the levator muscle, and any history of prior cosmetic eyelid procedures.
There are three main approaches to ptosis correction surgery:
- The posterior approach – this is the least invasive method. Here, an incision is made on the inside of the upper eyelid, meaning you will have no visible scar after.
- The anterior approach. This means an incision is made in the upper eyelid skin crease to access the muscle that lifts the eyelid. This is then tightened and reattached to the eyelid. This results in a “hidden” scar, which lies in your eyelid’s natural crease. Ptosis surgery carried out in this way allows the procedure to be combined with a blepharoplasty (eyelid lift) procedure, so that any excess eyelid skin can be removed at the same time.
- In cases where the muscle that raises the eyelid is damaged or weak, a strip of tissue can be taken from the thigh (fascia lata) or a non-absorbable material like silicon or prolene, and used to lift the upper eyelid by fixing it to the brow area. This technique is also called a frontalis sling because it involves using a sling made of synthetic material or the patient’s own tissue to connect the eyelid to the frontalis muscle (forehead muscle), allowing the forehead muscles to assist in lifting the eyelid.
To finish, your surgeon will close your incision with stitches. These might be visible on your eyelids, but will be removed around 1-2 weeks after surgery. You will also have a temporary patch or dressing covering your eye.
Ptosis correction surgery usually takes around 45-90 minutes, depending on which technique is used.
After
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery. Don’t worry about feeling pain as the anaesthetic wears off – our nursing team will provide you with pain relief, which you can also take home with you.
You should be able to go home within a few hours – however, you will need to have a friend or relative collect you as you will not be able to drive for a few days after surgery.
You can be back working from home the day after the procedure. However, if your work is physical or involves any heavy lifting, you should take 1-2 weeks off before returning to your job.
Your eyelid(s) will be bruised and a bit sore for 7-10 days after the procedure. Any discomfort should be easily managed with the provided pain relief. After 24 hours you can remove your eye patch. Don’t remove it early as it will help reduce swelling.
Keep the wound clean and dry and immediately contact your surgeon if you notice any signs of infection, such as swelling, redness, discharge, or pain. Your doctor will prescribe antibiotic eye drops, which you will need to use for several weeks post-surgery, and which will help reduce the risk of an infection.
Within 3-4 weeks, most, if not all, of the swelling around the eyelid should have subsided, and within 3 months, your eyelid should be completely healed.
You should avoid swimming, wearing contact lenses and make-up until the wound has completely healed.
Complications
Complications can include:
- Excessive bleeding, bruising and swelling of the eyelid
- Infection of the eyelid wound
- Over-correction (eyelid too high) or under-correction (eyelid too low)
Before you progress with surgery, your surgeon will discuss the risks and benefits in detail so that you can make an informed decision.
Medically reviewed by Dr Nick Koutroumanos - MBBS FRCOphth PgC Clin Ed FHEA on 13/12/2023
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