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WHAT CAUSES PTOSIS?
Ptosis can be congenital or acquired.
Congenital Ptsois
If it is present at birth it is called congenital
ptosis, and is usually due to poor development
of the muscle that lifts the upper eyelid (the
levator muscle).
If the ptosis is severe- fully or partially covering
the pupil of the eye- it can lead to "amblyopia"
(lazy eye) or strabismus
(eyes that are not properly aligned or straight).
In some cases the ptosis is also related to refractive
errors or astigmatism (an irregularity in the
shape of the cornea that causes blurred vision).
Acquired Ptosis
Most cases of acquired ptosis are characterised
on the basis of the history. 'Neurogenic' ptosis
is caused by a partial or complete paralysis of
the nerve innervating the levator muscle. 'Myogenic'
ptosis can be caused by facial weakness (such
as in myotonic dystrophy). 'Traumatic' ptosis
can be induced by trauma to the eyelid, and in
'mechanical' ptosis the upper eyelid may be prevented
from opening completely because of, for example,
an eyelid tumour which restricts the action of
the levator.
Another form of acquired ptosis is 'dermatochalasis',
which is the presence of excessive and redundant
eyelid skin and is almost always progressive with
ageing. Surgical correction may be indicated for
visual or cosmetic reasons.
WHAT ARE THE SYMPTOMS OF PTOSIS?
The foremost symptom of ptosis is an eyelid that
sags or droops. Patients will often tilt their
heads back or lift their eyebrows, in an expression
of surprise, in order to see (especially if bilateral
ptosis is present).
Among other symptoms, lax eyelids may cause headaches
and browaches, obscure the vision or irritate
the eye.
HOW IS PTOSIS TREATED?
The treatment of ptosis is largely surgical. Ptosis
surgery is designed to tighten the levator muscle
by shortening it to allow the muscle to sufficiently
elevate the eyelid. The eyelid is often carefully
compared to the opposite eye in terms of lid height.
In some cases where the levator is exceptionally
weak the eyelid is attached to the brow muscles,
with a 'levator sling', allowing the forehead
to elevate the lid.
Ptosis surgery is usually completed under general
anaesthesia in infants and young children and
under local anaesthesia with sedation in adults.
Ptosis surgery in adults is performed here at
Harley Place Day Surgery on a same day outpatient
basis.
WHAT CAN I EXPECT AFTER SURGERY?
After the procedure you will likely experience
some discomfort and the upper eyelid/s may feel
'tight' at first, although this sensation should
resolve within a few days. The elevation of the
eyelid will often be immediately noticeable, though
in some cases the bruising and swelling associated
with the surgery will obscure this finding. The
bruising and swelling will usually resolve in
2-3 weeks.
Dr Martin will prescribe antibiotic ointment and
drops as your eyes may feel sticky, dry and itchy
for up to a week following surgery. Any other
medications will also be prescribed if you are
experiencing discomfort.
Most patients will have sutures that need removing
about a week following the surgery. In some patients,
such as children, absorbable sutures are often
used. At 5-7 days post-op, reassessment is made
and if there is over-correction or under-correction
of the lid, adjustment of the sutures may be necessary
to better align the lid height.
Whether ptosis surgery is for medical or cosmetic
reasons, it is usually a straightforward surgical
procedure with a high rate of success.
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