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Surgical correction of ptosis

Published by Bupa's health information team, July 2009.

This factsheet is for people who are planning to have surgical correction of ptosis, or who would like information about it.

Ptosis is when your upper eyelid droops down. It is also called blepharoptosis. It can affect one or both of your eyelids. Ptosis is most common in older people, although you can be born with it.

Surgical correction of ptosis involves tightening the muscles around your eyelid so that it is lifted back to its normal position making both eyelids as symmetrical as possible.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About surgical correction for ptosis
What are the alternatives?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from surgical correction of ptosis
What are the risks?
Questions and answers
Related topics
Further information
Sources

About surgical correction for ptosis

The aim of surgical correction for ptosis is to lift your drooping eyelid back to its normal position. This is usually done by tightening the muscles used to raise your eyelid. If your ptosis is severe and your eyelid muscles very weak, the muscles in your brow may be used to lift your eyelid.

The operation is carried out by an ophthalmologist. An ophthalmologist is a doctor who identifies and treats conditions affecting the eyes, including surgical treatments.

The operation will restore the look of your eyelid so that it looks the same as your other eyelid. However, it can be difficult to get both eyelids perfectly symmetrical. Your ophthalmologist will discuss this with you before your operation.

What are the alternatives?

You can get special glasses with a crutch attached above the lens to hold up your drooping eyelid. However, most people with ptosis need surgery to treat it.

Preparing for your operation

Your surgeon will explain how to prepare for your operation.

The operation is normally carried out as a day case under local anaesthesia This completely blocks feeling from the eye area and you stay awake during the operation. For children, general anaesthesia is used. This means that your child will be asleep during the operation.

If your child is having general anaesthesia, he or she must not eat or drink for about six hours beforehand. Often the operation is planned for the morning, so that your child will only have to miss breakfast.

Your ophthalmologist will visit you before the operation. This is a good time to ask any questions. He or she will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the operation

There are several different surgical techniques that can be used to treat ptosis. The type of operation you have will depend on what your ophthalmologist considers most appropriate for your case.

Most surgical techniques involve identifying and then tightening your eyelid muscles and tissue using stitches. Your ophthalmologist will use measurements taken from your eyelids before your operation to determine how much muscle needs to be tightened. The operation is done through a small incision in the natural skin crease on your upper eyelid (this ensures that any scar remains hidden). The operation takes about an hour.

If the eyelid muscles are very weak, as is often the case with congenital ptosis, a different type of operation may be needed. This involves using muscles in the forehead to lift the eyelid. A sling of material is attached between the forehead muscles and the eyelid. The sling may be fashioned from tissue from your own body, for example a small strip of tendon from your leg. Alternatively, a synthetic material may be used. This operation is called a frontalis sling or brow suspension and takes around an hour and a half.

What to expect afterwards

After your operation, your eye may be covered with a dressing or eye pad. You may be asked to keep this in place for the first 24 to 48 hours.

If your child has had a general anaesthetic, he or she will be monitored for a short while after the operation. Your child may be groggy, and feel or be sick, and will need to rest on a bed or on your lap until the effects of the general anaesthetic have passed.

Normally, dissolvable stitches are used during the operation. Dissolvable stitches don't need to be removed. The length of time they take to dissolve depends on the type of stitch used. This is usually around two to three weeks, although it can take longer. If non-dissolvable stitches are used, they will need to be removed one week after your operation.

A nurse will give you advice about caring for your healing wounds before you go home. The wound should be kept clean and dry, and there shouldn't be any discharge from it.

You will be given antibiotic drops or ointment to use for one or two weeks after your operation. You may also be given a date for a follow-up appointment.

As you may only have the use of one eye (the other will be covered by a dressing or have ointment in it), it may be best to have someone drive you home after your operation rather than drive yourself.

Recovering from surgical correction of ptosis

Your upper eyelid will be red and swollen for about seven to 10 days after the operation. There may also be some bruising around your eye.

If you have any pain, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16.

Contact your GP or the hospital if you have severe pain, increasing swelling and redness of your eyelids or you have discharge coming from your eye or wound. These could be a sign that you have an infection.

The full effect of your operation may not become apparent until the healing process is complete. This usually takes a couple of months (sometimes longer).

What are the risks?

Surgical correction of ptosis is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure. For surgical correction of ptosis this may include pain, bruising and swelling around your eye.

Complications

This is when problems occur during or after your operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications specific to surgical correction of ptosis can include:

recurrence of the ptosis - the chances of this partly depend on the initial cause and the surgical technique employed
infection in the surgical wound or your eye
over-correction or under-correction of your eyelid which may mean you need another operation
your eyelids may not appear as symmetrical as they were before
drooping of the lid in the other eye - surgery may be necessary to correct this
your ability to close the eye completely may be impaired after surgery, this may be temporary but it can be permanent and may require further surgery to correct it
lumps can form on your eyelid as a result of the stitches used during the operation, these are usually temporary
turning of the lid either outwards (ectropion) or inwards towards the eye (entropion) - this may require further surgery to correct
excess lid skin - it may be possible to anticipate this and your surgeon may choose to remove any excess skin at the same time as correcting the ptosis

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.