Ptosis means a drooping of the upper eyelid. This can be present from birth or develop at any time afterward. It is often seen after injuries to the eyelid and maybe seen in people who wear hard contact lenses. The position of the eyelid can be corrected with surgery, and the type of operation required depends on the strength of the eyelid muscle. This can be assessed by measuring the movement of the eyelid from looking down to looking up.
In most cases, the eyelid movement is normal and the droopiness is due to the muscle which raises the eyelid having become detached from the eyelid. Surgery involves reattaching the muscle to the eyelid, either by making an incision in the skin of the eyelid and locating the muscle by dissecting backwards or by making an incision underneath the eyelid and locating the muscle by dissecting forwards.
Less commonly, the muscle is weaker than normal and so it needs to be shortened in order to raise the eyelid. In cases of extreme weakness, operating on the muscle itself does not raise the lid significantly and a different type of operation is required, whereby a thin band of material (which could be a tendon, nylon or silicone) is attached to the eyelid (underneath the skin) and this band is then passed under the skin to the forehead. By contracting the forehead muscle, the eyelid is raised.
There is a choice of anaesthesia for ptosis surgery. Many people have the operation under local anaesthetic. An injection is placed underneath the skin of the eyelid, which very quickly becomes numb. As the surgery takes place above the edge of the eyelid, you can’t see what is going on. If the thought of being fully awake for the operation is not for you then some intravenous sedation is used to make you sleepy. However, towards the end of the operation, you need to be responsive to help with the adjustment of the eyelid height, to match one eyelid with the other. Sedation can only be used for people who have had nothing to eat or drink for six hours beforehand, and so needs to be planned ahead. This will be discussed with you if you decide to go ahead with surgery.
After the operation there will be some bruising and puffiness around the top eyelid. After sleeping, the bruising and swelling can also involve the lower eyelid and to reduce this, it is helpful to sleep with an extra pillow to raise the head slightly and to help dissipate the swelling. Usually, antibiotic drops are used during the day and antibiotic cream at night time. The eye can feel dry for a few days after surgery and so lubricating eye drops can also be helpful.
It takes from a few days to a week for the bruising around the eyelid to settle. However, the swelling or puffiness persists for longer and it can be a few weeks at least, before it is possible to properly assess the success of the operation, by comparing the eyelids together. At this stage it is sometimes necessary to adjust the height of the eyelid, either by massaging the eyelid to gently lower it or by adjusting the stitches which attach the eyelid muscle to the eyelid in order to raise the eyelid.
(click and drag the centre line on the images below to see before and after examples)