Ptosis: Illustrated representation of a normal eyelid and a drooping eyelid, where the distance between the eyelid and the pupil is reduced.
Ptosis 2: A real patient, before and after the correction of a drooping eyelid without blepharoplasty, since this patient had only a drooping eyelid without excess skin.
[message_box title=»» color=»blue»]Drooping eyelid or eyelid ptosis is a descent of the upper eyelid that occludes the eye to varying degrees. The patient cannot normally open his eyes, which can interfere with vision if the eyelid covers the pupil.
The main consequence for adult patients, aesthetic considerations aside, is the loss of the upper visual field. When the condition is bilateral and appears slowly, it can go unnoticed by the patient for a long time, but when it is unilateral, it is very easily noticed, no matter how slight it may be.
In children, a drooping eyelid can cause lazy eye (amblyiopia), since the eye does not receive enough visual stimulation for vision to develop normally.
Causes of eyelid ptosis
In adults, it usually appears progressively and the most common cause is the detachment of the muscle that raises the eyelid (levator muscle); in other words, the connecting tendon (levator aponeurosis) loses contact with the eyelid and thus loses the ability to raise it effectively.
Congenital ptosis (present at birth) is normally due to an isolated alteration of the levator muscle during embryonic development; therefore, despite being well connected to the eyelid, is weak and cannot raise the eyelid normally.
There are other less common causes: allergic reactions, muscle and neurological diseases, and trauma.
Additionally, in rare cases where eyelid ptosis appears suddenly within a period of days or a few weeks, examination and imaging tests must be performed in order to rule out serious conditions like aneurysms or brain tumors.
Treatment of eyelid ptosis
The treatment of eyelid ptosis is surgical, and different techniques may be used depending on each case. In any event, eyelid surgery is always performed on an outpatient basis with local anesthesia and i.v. sedation in adults.
We can divide the surgical techniques in terms of their approach as follows:
- Transcutaneous (through the skin): The primary lifting muscle is strengthened through a cutaneous incision made in the eyelid’s natural fold, so the incision is not visible. This is the same incision that is made for a blepharoplasty, and the two procedures can be performed together.
- Transconjunctival (Putterman technique): Involves strengthening the muscle transconjunctivally. In other words, there is no skin incision; as a result, there is no scar.
- Frontalis sling: When the levator muscle is degenerated, which can occur as a result of congenital ptosis or muscle diseases, the abovementioned procedures do not work. This technique involves connecting the eyelid to the frontalis muscle in the forehead. The patient will then be able to open his or her eyes by raising the eyebrows using the frontalis muscle.
[message_box title=»» color=»red»]To determine which technique is most appropriate for each patient, a detailed examination must be performed during the consultation.
In children, treatment is usually postponed if ptosis is slight and there is no risk of lazy eye (amblyiopia). If ptosis is more pronounced and there is a risk of amiblyiopia, treatment must be carried out early. In children, the procedure is performed under general anesthesia.
[toggle_item title=»Recovery»]The post-operative process for ptosis surgery is very similar to that of an upper blepharoplasty. The patient usually leaves with his eyes uncovered and the only thing to be expected in the following days is swelling and small bruises, which will disappear within 5 to 14 days, depending on the patient. It is important to apply cold during the first few days in order to shorten the process. We also recommend using lubricating eye drops and applying ointment to the sutures, which will be removed after one week.
For transconjunctival surgeries, recovery is even faster. The bruises, if they appear, are minimal, and in 10 days recovery is practically complete.
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Upper blepharoplasty, Lower blepharoplasty, Blepharoplasty. Corrective surgery, Drooping eyelid y eye surgery
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