Eyelid ptosis is a drooping of the upper eyelid. It is usually caused by detachment or weakness of the muscle which raises the eyelid (levator muscle). A droopy lid may block your vision and you may need to use your forehead muscles to try to lift your eyelids.
Ptosis may be due to aging, trauma, contact lens wear or eye surgery. It may also be congenital (present at birth). Some rare muscle diseases or autoimmune disease such as myasthenia gravis can cause a ptosis.
The aim of ptosis surgery is to raise your upper eyelid. This may improve your visual field and may improve the cosmetic appearance. There are a number of different surgical techniques to raise your lid depending on the cause of your ptosis. The operation is usually carried out under a local anaesthetic as your cooperation is needed to try and accurately set the height of your upper lid. After anaesthetic eye drops have been inserted, local anaesthetic is injected into the lid to numb the area and the operation is then carried out. You may go home the same day.
Occasionally it may also be carried out under local anaesthetic with sedation or a general anaesthetic.
A ptosis prop is a simple thin plastic arm which attaches to a pair of glasses. When the glasses are put on it gently pushes the eyelid upwards. It can be quite effective but is usually reserved for people who can’t have, or don’t want, surgery.
If you are taking aspirin or any other blood thinners you will need to inform your doctor as you may need to stop these. This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery. All herbal medicines should be stopped at least 14 days before surgery. If you are on Warfarin you should have an INR test within the 5 days before surgery and bring the result of this to surgery.
Smoking impairs healing and if possible you should try to stop 6-8 weeks before surgery. If you have high blood pressure ensure that this is well controlled as it will make you more likely to bleed and bruise.
Please bring with you a list of your current medications with details of any known allergies. You will not be able to drive yourself home after the procedure. Please arrange for someone to accompany you home.
If you are in any discomfort take painkillers such as Paracetamol or Ibuprofen. If your wound begins to bleed, apply pressure to the area with a clean pad for 10 minutes. If the bleeding does not stop seek medical attention.
You should keep the incision clean using clean cotton wool and sterile saline solution or boiled cooled water. You will also need to use eye drops or ointment 4-6 times a day for at least 2 weeks to keep the eyes lubricated.
After surgery you should avoid makeup for 1 week and contact lenses for 2-4 weeks. Cool compresses or ice packs should commence as soon as the pad is removed, or immediately if there is no pad, for 5 minutes 4 times a day for the first 2 days to help the swelling and bruising. You may wrap a bag of frozen vegetables in a clean tea towel to do this or buy an eye cool pack from your pharmacist.
People vary in how quickly the swelling and bruising improves. Bruising will usually improve over 2-3 weeks. Swelling takes longer; most will go away over 3-4 weeks. Swelling and bruising may track into your upper cheeks causing swollen lower lid eye bags this will improve over time.
Many people return to normal activities after 2-3 days. Try to avoid strenuous activity for 2 weeks after surgery to help your wounds heal.
The lid scars fade to a white line over a number of months. Most of the scar will be hidden in your natural lid creases. Sunlight can impair the healing of your scar so it is useful to wear sunglasses in sunny conditions whilst you are healing.