A Guide To Ptosis Surgery 2023
Ptosis (Droopy eyelid) surgery is often confused with double eyelid surgery. This is because both types of surgery result in the formation of a double eyelid crease. However, ptosis surgery differs in that it is performed on those with eyelids which are already ptotic (droopy). The aim of ptosis surgery is to lift up the droopy/ptotic eyelid.
How do you know if you have ptosis?
- Received comments that you have a sleepy appearance.
- Felt that there is partial obstruction of the top portion of your vision, and that you can see better and have brighter vision when you manually lift up your eyelid with your fingers.
- The eyes appear smaller than before.
- A tired feeling around your eyes due to an involuntary compensatory mechanism by using the eye brow muscles to lift up the droopy eyelid, which often leads to a tired sensation around the forehead area.
- Sometimes, headache results due to tension around the eyebrow and forehead muscles.
In other words, you may not even realise that you have ptosis due to these involuntary mechanisms.
How do we diagnose ptosis?
- We shine a light at your eyes and take specific ruler measurements.
- The distance between the upper eyelid margin and the light reflex will determine the degree of ptosis. In severe ptosis, the eyelid covers 50% or more of the pupil.
Marginal Reflex Distance (MRD)
How does a person develop ptosis?
The commonest causes of the droopy eyelid includes:
- Aponeurotic ptosis – eyelid drooping due to an ageing/degenerative process of the eyelid’s supporting anatomical structures. Aponeurotic ptosis can also be caused by long-term contact lens wear, previous eye surgery or eyelid infections.
- Trauma from previous injury to the eyelid region, or even habitual vigorous eye rubbing.
- Congenital ptosis – in some cases, one could have been born with ptosis.
- If there is a sudden occurrence, then it would be prudent to see your eye specialist urgently for further assessment to rule out more sinister causes such as a brain nerve compression or a nerve-muscle junction disorder.
Aponeurotic ptosis can involve one or both upper eyelids. Droopy eyelid is usually a gradual process if it is due to aponeurotic ptosis.
What is the treatment for ptosis?
If you do have ptosis (droopy eyelid), you will likely benefit from ptosis (droopy eyelid) correction surgery. It is a day surgery procedure which involves moderate sedation. Tests will be performed to determine the severity of ptosis.
What are the possible risks or complications from ptosis surgery?
The risks are generally very low, the most common risk being that of dry eye after surgery. Lubricating eyedrops will be prescribed to protect your eyes from dryness during the first 2 months after surgery.
Other risks include:
- Bleeding/bruising – To avoid pro-bleeding supplements 4 weeks prior to surgery, including some traditional Chinese medicine, Vitamin E, omega oils and garlic pills.
- Infection – To avoid soap on the wounds immediately after surgery.
- Swelling/puffiness – To place ice packs around the eyelids to reduce swelling/puffiness as much as possible in the first few days after surgery. The swelling will subside over the next 4 weeks to a few months.
- Risks of sedation are minimal as long as you are in good general health.
How is ptosis surgery performed?
- You will lie down and be sedated throughout most of the surgery.
- Surgery is therefore painless.
- Your oculoplastic surgeon will first do the specific markings on your upper eyelids.
- A local anaesthetic injection will then be given to each upper eyelid.
- The surgery itself involves an incision along the intended double eyelid crease line.
- Excess fat and skin are removed at the same time.
- The levator aponeurosis which was dehisced (gape or burst open), is now reattached to its original position on the supporting cartilage (tarsal plate) of the upper eyelid.
- You will then be asked to open your eyes halfway through surgery to allow your oculopastic surgeon to adjust the height and contour of your eyelids.
- The surgery will end upon skin closure with absorbable sutures.
The surgery can be combined with other eyelid procedures, most commonly brow lift surgery.
- There will be post-operative oral and topical medications to aid the reduction of swelling.
- Specific post-operative care of the wounds will be advised.
- Most people do not require any pain relief medications.
- Follow-up appointments will usually be 1 day after surgery, 1 week after surgery and 6 weeks after surgery.
ABOUT DR EUGENIE POH –
OCULOPLASTIC SURGEON IN SINGAPORE
The Senior Consultant Ophthalmologist at Eye Max Centre, Dr Eugenie Poh has more than 20 years of experience in the treatment of eye conditions including cataract, ptosis, glaucoma, dry eye and retina diseases. Dr Poh had the opportunity to complete advanced training fellowships in oculoplastic surgery and trained with some of the top oculoplastic experts in the world. Read more about Dr Poh here
ABOUT EYE MAX CENTRE –
EYE SPECIALIST CENTRE IN SINGAPORE
A comprehensive one-stop specialist centre treating a wide range of eye conditions including cataract, glaucoma, retinal diseases and eyelid issues, we go to great lengths to ensure you receive personal and professional care for your eye conditions. Read more about Eye Max Centre here.