Where one or both eyelids droop abnormally

Ptosis occurs when your eyelid muscle and tissues are not strong enough to lift your eyelid to a normal position. It may range in severity. Ptosis can obstruct your vision when the eyelid covers part or all of the pupil and affect your appearance.

What causes ptosis?

The most common cause of ptosis is the weakening or stretching of the thin tendon of the muscle that lifts the eyelid. This can occur due to aging, eye surgery, prolonged contact lens wear, or injury. Some people are born with ptosis.

How is ptosis treated?

Eyelid surgery is the treatment for ptosis. It involves elevating the eyelid and reattaching it to healthy tissue of the eyelid muscle. The surgery may be performed externally through an incision along the crease of the eyelid fold, or internally by approaching from under the eyelid.

In most cases, eyelid ptosis surgery is all that is required, but occasionally additional surgery may be recommended, such as eyelid skin reduction surgery (known as a 'blepharoplasty') or eyebrow lifting surgery.

The surgery is generally performed in hospital under local anaesthetic but it can be done as an in-office procedure. Ptosis surgery in children requires general anaesthesia.

Pre-operative assessment

Before planning your surgery, Dr Parker will assess the impact of the ptosis on your appearance and vision and determine if one or both eyelids require surgery.

A careful examination of the eyelid structure and eyelid movements can help him understand the cause of the ptosis. Occasionally, additional investigations such as blood tests or CT imaging may be required, and sometimes, a consultation with a neurologist will need to be arranged.

How ptosis surgery is performed

Dr Parker marks the area to be treated, before instilling antiseptic drops into the eye. Local anaesthetic will then be injected around the eye. Once the anaesthetic takes effect, the area around your eye will feel numb.

Most people report that undergoing eyelid ptosis surgery is a comfortable experience, despite being awake for the procedure.

Being awake during the procedure allows Dr Parker to make precise adjustments to the eyelid position by asking you to open and close your eyes.

At the end of your surgery, an eye ointment will be applied to protect the surface of the eye. This may temporarily blur your vision. Additionally, a light dressing may be placed over your eye to help reduce swelling during the initial post-operative period.

After your ptosis surgery

After you go home, it is important to keep the eyelid wound clean by applying antibiotic ointment and practicing gentle wound care. Mild bruising and swelling of the eyelid can be expected, which typically subsides gradually over a few weeks. To help reduce swelling, cold water compresses should be applied frequently during the first three days.

For the first few days following surgery, it is best to sleep with your head elevated on several pillows and continue with cold compresses.

Avoid exercise or activities that may increase your heart rate or blood pressure for the first one to two weeks.

During the first six weeks, artificial tears may be helpful in keeping the eye surface moist since blinking and closing your eye may feel slow and uncomfortable.

Your first post-operative visit will be scheduled several days after surgery to assess your progress, remove sutures, or check dissolvable sutures. At this visit, Dr Parker will review the resting position of the eyelid and additional post-operative visits may be scheduled over the next few months until healing is complete.

While bruising and swelling usually subsides after two weeks, it may take up to six weeks for the eyelid to heal and for the outcome to be assessed as stable. Most people return to driving and normal activities within two weeks.

Although the improvement gained from surgery is permanent, the aging process continues, and occasionally, even if the early eyelid position is excellent, ptosis may recur well after the healing phase.

Challenges and limitations of ptosis surgery

Eyelid ptosis surgery can be a challenging procedure, and achieving the desired outcome may not always be possible. One of the main challenges is achieving symmetry between the right and left eyelids while also meeting your expectations for eyelid position, shape, and skin fold definition.

Most people are satisfied with the results of ptosis surgery. However, even in experienced hands, the results can be unpredictable. Over-correction, under-correction, eyelid contour changes, or asymmetry between the eyelids is possible. Up to 15% of people require more than one surgery to achieve a satisfactory outcome. The timing of a second surgery would depend on your specific situation.

The risks with ptosis surgery

Problems with wound healing, such as infection, inflammation and poor healing of the surgery incision are all very uncommon after ptosis surgery.

For the first few days after surgery, your eyelids may be slow to blink and close.

Your eye/s may feel dry and this feeling can persist for some time after surgery. Occasionally there may be longer term impaired closing or blinking of the eyelids requiring treatment.

Eyelash misdirection, even when the eyelid position is satisfactory, has been reported.

In any upper eyelid surgery, fine sensory nerves of the skin just above the eyelashes are cut, and it may take some months for the feeling to return to normal.

Rare, but potentially severe complications could include:

  • Haemorrhage around and behind the eye causing vision loss
  • Severe infection or inflammation
  • Double vision due to problems with eye movement muscles

Overall, eyelid ptosis surgery is a commonly-performed oculoplastic surgery procedure with an acceptably low risk of complications. It can improve your field of vision, as well as the appearance of a drooping eyelid.

If you would like to have a drooping eyelid corrected, make an appointment to see Dr Parker for a comprehensive diagnosis and treatment plan.

If you would like to have a drooping eyelid corrected, make an appointment to see Dr Parker for a comprehensive diagnosis and treatment plan.